The Medicare Thread

[KQ]

Brilliant!



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[old goat]

This is what Advamtage plans do already, except it's done by low level clerks instead of AI. The idea to prevent people from getting unnecessary procedures that generate income for doctors. Worthwhile on its face but obviously giving financial incentives to deny is just as bad. The only solution to the problem of unnecessary treatments and improper denials is to get the financial incentives out of medicine. The doctors should be salaried and the payers should have no say one way or the other. It worked for me as a surgeon with Kaiser and works for me as a patient.

[XXX-er]

As I understand it Up here they just give the MD a number they use to claim for payment by the government directly no insurance companies, I supose they could try fraud but how many times is that gona work before they will get booted form the system, they all seem to be really busy ?

ski bro told me his number was 666 which is the sign of the devil I suggested

[m2711c]

If only Cono was here to help us understand the whole situation.

[tom tuttle from tacoma washington]

Just notified CIGNA (My Part B Provider) sold to Health Care Service Corp. Too bad, they were relatively cheap and easy to deal with.

[liv2ski]

This is what Advamtage plans do already, except it's done by low level clerks instead of AI. The idea to prevent people from getting unnecessary procedures that generate income for doctors. Worthwhile on its face but obviously giving financial incentives to deny is just as bad. The only solution to the problem of unnecessary treatments and improper denials is to get the financial incentives out of medicine. The doctors should be salaried and the payers should have no say one way or the other. It worked for me as a surgeon with Kaiser and works for me as a patient.

OG, what do you think of the advantage plans. I am on one in San Diego with Sharp and it's supposed to be a good plan but you still have to get approval on many services that Medicare would just do.
I save a few bucks by doing the advantage plan but is that really the smart way to go?
Please tell me what to do Brain trust.

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[mcski]

medicare advantage plans are all HMOs. If that’s the way your ok w rolling that fine i guess. Persinally, i firmly believe OG Medicare and a supplement are better choice all around. Supplemental Premium might be a bit more but everything will be covered and no HMO hoops to jump through and you can go to the best specialists anywhere if needed. This is one area Cono actually knew something about. Check out some posts he’s commented on

[up an down]

For accurate Medicare/ Medicaid/ SS info I watch a YouTube channel by Ed Weir . who was in charge of a SS office for years..he also has a website. MyGovExpert.com

[old goat]

OG, what do you think of the advantage plans. I am on one in San Diego with Sharp and it's supposed to be a good plan but you still have to get approval on many services that Medicare would just do. I save a few bucks by doing the advantage plan but is that really the smart way to go? Please tell me what to do Brain trust. Sent from my moto g stylus 5G (2022) using Tapatalk

Depends on the plan. OG Medicare incentivizes doctors to do more. Advantage incentivizes insurers to do less. Neither is good. As I said I'm satisfied with Kaiser because the health plan leaves the doctors alone to do what's right with no financial incentive to do more or less. The only check on the doctors is peer quality review, as it should be. Like any HMO you have to get nonemergent care in network but the network is very big and stable. No surprise bills. Excellent coverage for emergency care outside of Kaiser, including out of country. I had a $400K bill for my broken back, including ambulance and transfer to Kaiser by fixed wing flight completely covered. I later had a very complex heart operation done by a Kaiser surgeon (ex Texas Heart) done at a non-Kaiser hospital. I do get some perks like a gym subscription but not as good as some of the other plans. Kaiser is in San Diego.

[liv2ski]

Thanks for your response OG. I had Kaiser probably 30 years ago and it worked well for me as I was rarely sick. Had a good buddy who was an ICU nurse. He suggested with my father's history of a bad heart to stick with Sharp as they were way better with hearts than Kaiser.
In the event of a heart attack he said Sharp is way better.

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[tom tuttle from tacoma washington]

OG for clarity sake and if I missed I apologize.
Is your Kaiser an advantage or Trad. Part B plan?

FWIW my oldest sister is on a Kaiser legacy advantage plan (Medicaid- I don't think she pays very much if anything) from my mothers time working for RCA/GE, she is special needs, SSDI, and I have been very impressed with what they have been willing to cover. Example: 74 year old (F) in not great health and a Cancer history (they were great on those scares). Last month they paid for a freaking Bunionectomy and the recovery (2.5 days) and PT as well as someone to drop by every few days even though my other sister lives 2 miles away and sees her daily.

I wonder how they make that back?

[old goat]

My Kaiser is Advantage. AFAIK (which is less than I should as an ex Kaiser doc) Advantage type plans are the only plans Kaiser offers for medicare and nonmedicare.I don't know anything about Sharp in San Diego.