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NY Docs Sue UnitedHealth for Dropping Docs from Med AdvNetworks

Rainbow Girl's picture

That's 2,000 doctors. And what is more, the networks in question are in the UHC Medicare Advantage plans. So the patients losing their doctors are the elderly with serious ongoing conditions. Medicare Advantage plans are, in short summary, the private insurance supplemental plans that Medicare eligible persons with enough money to pay for them get in order to not have to pay for the Medicare A and B no-out-of-pocket-limits, 20% co-insurance, and for "Medicare" prescription coverage. So ObamaCare is apparently launching the missiles to turn Medicare private plans into overpriced and useless skinny Medicaid plans.

Here's a particularly vicious fact from the Department of They Wouldn't Do That Except Yes, They Would, Because Insurance Companies Screw Policy Holders for a Living:

Medical Society President Sam Unterricht told The Post the company’s decision was unfair to patients, since they had to choose a new plan under Medicare Advantage, a private alternative to traditional Medicare, by Dec. 7, when company Web sites still showed doctors who were being kicked out of the network at the start of the new year. [Isn't this a Bait & Switch and illegal under various consumer fraud statutes? And so much for the elderly who wasted days, hours and nervous-system-power researching their plans to make sure their providers were in-network (one of their most solemn, civic responsibilities now that they have "choice and control" over their healthcare) -- that time was a complete waste and a useless tax on them.More gratuitous cruelty against vulnerable citizens.]
“For some people who are medically fragile it can really be dangerous. There can be gaps in care,” he said.

Well, I suppose Obama could make a speech on January 1, 2014, telling those elderlies facing "gaps in care" to learn to be flexible and nimble in this new age of constantly-shifting-things. And, you know, maybe reinvent themselves as People Who Don't Need Medical Care. Just do a few push ups every morning, granny, and you won't need any of that expensive care for rheumatism, degenerative joint disease, or diabetes.

Average: 5 (1 vote)


Alexa's picture
Submitted by Alexa on

they simply pass it on. Think that I've said that here more than a few times.


But I would blame the Democratic Party policy wonks and staffers along with the insurance industry "authors" of the ACA.

All of the actors knew, or should have known, the consequences of cutting funding for the Medicare Advantage program.

No "unintended consequences" here.

Submitted by lambert on

I confused one neo-liberal infestation with another....

Could be my knee is jerking when I read " offered by a private company that contracts with Medicare" though?

UPDATE No, it isn't. Commonwealth Fund:

The Medicare Modernization Act of 2003 explicitly increased Medicare payments to private Medicare Advantage (MA) plans. As a result, MA plans have, for the past six years, been paid more for their enrollees than they would be expected to cost in traditional fee-for-service Medicare. Payments to MA plans in 2009 are projected to be 13 percent greater than the corresponding costs in traditional Medicare—an average of $1,138 per MA plan enrollee, for a total of $11.4 billion. Although the extra payments are used to provide enrollees additional benefits, those benefits are not available to all beneficiaries—but they are financed by general program funds. If payments to MA plans were instead equal to the spending level under traditional Medicare, the more than $150 billion in savings over 10 years could be used to finance improved benefits for the low-income elderly and disabled, or for expanding health-insurance coverage.

Alexa's picture
Submitted by Alexa on

and ironically, much of the privatization of our social safety net was begun under the Clinton Administration (including HUD vouchers, etc.).

Not to mention the beginning of the "Faith-Based Initiative" signed by FP Clinton--via John Ashcroft's "Charitable Choice" Amendment.

This law opened the door to the heavy participation of conservative churches [all chuches are allowed--but most "liberal" churches object to the blurring of the lines between church and state] in our social service programs.

Which I often and loudly strongly object to!

Alexa's picture
Submitted by Alexa on

that has nothing to do with the rationale for the Dem Party to defund Medicare Advantage (from what I've read).

Certainly, I was totally against it initially. And we don't know anyone personally who is enrolled in it.

But, I must say--MA is touted by many C-Span callers to Washington Journal [the call-in program].

And MA offers valuable types of coverage that traditional Medicare does not--dental care, vision care and RX. [Not certain that all MA policies do--but they are available, and this is one reason that about one-quarter of Medicare beneficiaries opt for these policies.]

THIS is the reason that Dems decided that it must go--that, and they did not want to fund Medicare Advantage premiums at a higher rate, even though these policies clearly offers benefits that many seniors badly need.

From what callers say, they also include RX benefits--which is good if a senior cannot afford a stand-alone RX policy

This week, Mr A will have to spend a small fortune (including a endodontist specialist's high fees) for a root canal, two crowns, etc.

Don't know what we'd do without dental insurance, frankly. Dental work is still expensive--since the coverage for "major restorative--other than filings--is 50/50.) But at least the filing will be covered at 80/20, and they're not cheap. And, of course, his insurance allows for 4 standard or periodontal cleanings per year (per enrollee). I'm also scheduled for a couple of crowns. Including periodontal treatment slated for Mr A in a couple of months, we would be out easily $10,000 for about four dental visits and one endodontist visit in the next several months--were it not for dental insurance.

So, until they include this benefit in traditional Medicare, I'm not absolutely sure that I'm happy with the cuts to MA.

So I'm not impressed with the decision to cut this program--it is simply part of the Dem Party agenda to slash the social safety net.

And remember, this Administration has a test pilot program to "transform" traditional Medicare into an HMO or MCO type program set to start in Virginia on 1 Jan 2014.

Now, would I rather have these additional benefits as part of traditional Medicare--sure.

But for now, that looks like a pipe dream.

(Remember the 12-year-old boy in Maryland who died from an abscessed tooth several years ago? I do.)

Offering seniors an affordable way to bear the expense of dental care ought to be part of any Medicare program, IMO.

Submitted by lambert on

The privatization brings some benefit, and develops a constituency, among:

  • Rent seekers
  • Providers
  • Consumers

and the opportunity costs are the real services we could provide with the rents ($150 billion above) and the distortions of profit-seeking by the providers. All these entrench the program, and I'm sure ObamaCare uses the same play from the same playbook.

That said, I wouldn't have cut it, for the same reason I think ObamaCare should be replaced not repealed; I don't want the improvement to come on the basis of suffering and throwing some under the bus.

But let's be clear on what MA is, systemically; "successful" programs like it are how Medicare and Medicaid and the entire social insurance system are going to be nibbled to death because free markets.

jo6pac's picture
Submitted by jo6pac on

Yes very true, in conversation with my pharmacist the other day he told me if you don’t join Medi-Care B, C, & D right in the beginning there is a penalty you pay and it comes right out of your SS account. It is a monthly charge and was a real eye opener to some of his older clients. It didn’t matter if it was a demodog plan or repug plan they all made money for the pill companies. He also told me 4 small pharmacist like him sold out this year in the Sacramento, Calif. area because the govt. is slowly forcing everyone to the big 4 drug stores. It just another attack on Main Street and any one that says this isn’t the Grand Plan is nuts and it is going real well under a so-called demodog potus.

Alexa's picture
Submitted by Alexa on

doesn't give a single-payer option (I don't count Medicaid), so I'm not sure that I would make that comparison.

Bottom line: Paul Ryan has collaborated with two Democrats--Alice Rivlin and Ron Wyden to formulate Medicare "voucher" programs.

And they have not "canned" this idea, IMO. (Just put it on the back burner, for now. Incrementalism, you know.)

My concern is that this relatively full-featured (so to speak) private Medicare insurance product will be replaced with a privatized and much-pared-down version of "traditional" Medicare (under the ACA and further cuts to the "traditional" Medicare program that I constantly harp on--Medigap Policy changes, which will raise the Medicare premiums for some, raising the eligibility age to 67, further "means testing" of Medicare, etc.).

Considering all these "reforms" in the hopper for traditional Medicare, I actually hope that they don't completely eviscerate MA--at least not until we see what is left standing of the old Medicare program.

We're both years away, and don't expect it ever enroll in Medicare--won't need it, if not state-side. But we've seen friends and family who are fretting about the cuts that have already been made to Medicare. One of my sibling's benefit is skimpy in several areas compared to our Mother's--and she passed away recently--and he retired recently.

I think that we should not have a false sense of security about "traditional" Medicare--at the rate that Dems are attempting to dismantle the program, it won't much matter if it is called single-payer or a private policy.

Unfortunately, most progressives (not including you) are content with all the cuts, or don't realize what they are and will be, and are not pushing back on them.

Until we raise awareness of the Dem Party agenda regarding Medicare "reform," we can't begin to win this fight (I'm afraid).