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Let's talk Medicare part C. Phone lines are open now.
Let's talk Medicare part C. Phone lines are open now.
By PhiloBeddo
6 Dec 2024 10:18 am in No Holds Barred Political Forum
11 Dec 2024 2:15 pm
Buffalo » 11 Dec 2024, 2:54 pm » wrote: ↑ The CMS!!! Why do you think medicare advantage insurers balk at audits?
They also DENY claims!!!
CMS can already look at claims.
11 Dec 2024 2:17 pm
Buffalo » 11 Dec 2024, 2:49 pm » wrote: ↑ The doctors’ group Physicians for a National Health Program (PNHP) just published a shocking report on the extent of the Medicare Advantage ripoffs — both to individual customers and to Medicare itself — that every American should know about.
The report, titled Our Payments, Their Profits, opens with this shocking exposé:
“By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these — or other crucial aspects of Medicare and Medicaid — could be funded entirely by eliminating overcharges in the Medicare Advantage program.
“Medicare Advantage, also known as MA or Medicare Part C, is a privately administered insurance program that uses a capitated payment structure, as opposed to the fee-for-service (FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care of beneficiaries, the federal government gives a lump sum of money to a third party (generally a commercial insurer) to ‘manage’ patient care.”
With real Medicare and a Medigap plan, you talk with your physician or hospital and decide on your treatment, they bill Medicare, and you never see or hear about the bill. There is nobody between you and your physician or hospital and Medicare only goes after the payment they’ve made if they sniff out a fraud.
With Medicare Advantage, on the other hand, your insurance company gets a lump-sum payment from Medicare every year and keeps the difference between what they get and what they pay out. They then insert themselves between you and your doctor or hospital to avoid paying for whatever they can.
https://www.commondreams.org/opinion/me ... -is-a-scam
MEDICARE ADVATAGE PLANS ARE A GODDAMN RIP OFF!!!
you PROOF is a bunch of lefties that don't like corprorations...ok.
11 Dec 2024 2:20 pm
Buffalo » 11 Dec 2024, 2:40 pm » wrote: ↑ You need to do some research and learn what you are talking about, ****!!! You must be one of those free loaders that want to get something for nothing.
The taxpayers are the ones getting harmed!!!
Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have. Health insurers that treat millions of seniors have overcharged Medicare by nearly $30 billion the past three years alone as of 2019. $10 BILLION a year will cause Medicare to go broke!!!
The insurance lobby, though, is powerful and owns many politicians. Efforts by the CMS to audit insurance programs like medicare advantage by the CMS have been met with strong opposition.
I paid into the Medicare system since 1968 and I like it. Hospitals cannot get by with overbilling, which they do on a regular basis. All minor and major medical bills I have had that Medicare only paid 80%, I can pay out the 20% monthly at less that private insurance premiums. Why do freeloaders like you have a problem with paying for your own ****?
Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.
It is getting worse by the year!!!
Opinion | Medicare Advantage: The Scam You Can't Afford to Ignore | Common Dreams
My brother is a medical doctor and he sees the scam!!!
you are talking about piss ant outpatient claims where you paid 20% of some tiny approved amount. What did you pay for your hospital stay. How much will you pay for Part B drugs? why do you keep posting lefty propaganda opinion pieces as proof?
11 Dec 2024 2:21 pm
Buffalo » 11 Dec 2024, 2:53 pm » wrote: ↑ Hospitals are known for exaggerating medical issues for their own benefit, too!!!
My brother is a medical doctor, he sees this EVERYDAY!!!
Why does your brother exaggerate claims?
11 Dec 2024 2:22 pm
Really??
So tell that mother of 3 kids who just got that Life Insurance check from where her HUSBAND got killed in a car accident how it's a "racket".
https://i.postimg.cc/JhtbP0JB/Dismissed-Evidence.jpg
Liberals are spoiled children, miserable, unsatisfied, demanding, ill-disciplined, despotic & useless. Liberalism is a philosophy of sniveling brats ~O'Rourke
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
11 Dec 2024 2:25 pm
Really??Buffalo » 11 Dec 2024, 2:54 pm » wrote: ↑ The CMS!!! Why do you think medicare advantage insurers balk at audits?
They also DENY claims!!!
I can show you a CLAIM for a PART B drug that is over $6,000 PER INJECTION and the Medicare Advantage plan FULLY approved it's use.
And the Part B claim on that WOULD have been 20%, or $1200 PER INJECTION and there can be from 4-6 per YEAR that are needed.
So try to explain your **** when the FACTS don't line up!!
https://i.postimg.cc/JhtbP0JB/Dismissed-Evidence.jpg
Liberals are spoiled children, miserable, unsatisfied, demanding, ill-disciplined, despotic & useless. Liberalism is a philosophy of sniveling brats ~O'Rourke
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
11 Dec 2024 2:27 pm
Medicare pay's bills when they are presented. You are correct! This is why their is so much fraud in Medicare and Medicare doesn't really check because they DONT FREAKING CARE. It's not THEIR money!Buffalo » 11 Dec 2024, 2:40 pm » wrote: ↑ You need to do some research and learn what you are talking about, ****!!! You must be one of those free loaders that want to get something for nothing.
The taxpayers are the ones getting harmed!!!
Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have. Health insurers that treat millions of seniors have overcharged Medicare by nearly $30 billion the past three years alone as of 2019. $10 BILLION a year will cause Medicare to go broke!!!
The insurance lobby, though, is powerful and owns many politicians. Efforts by the CMS to audit insurance programs like medicare advantage by the CMS have been met with strong opposition.
I paid into the Medicare system since 1968 and I like it. Hospitals cannot get by with overbilling, which they do on a regular basis. All minor and major medical bills I have had that Medicare only paid 80%, I can pay out the 20% monthly at less that private insurance premiums. Why do freeloaders like you have a problem with paying for your own ****?
Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.
It is getting worse by the year!!!
Opinion | Medicare Advantage: The Scam You Can't Afford to Ignore | Common Dreams
My brother is a medical doctor and he sees the scam!!!
Medicare loses billions of dollars each year due to fraud, errors, and abuse. Estimates place these losses at approximately $60 billion annually, though the exact figure is impossible to measure.
And here you claim that tax payers are getting ripped off by Advantage plans....Advantage plans cost $30 million in 3 years while Medicare loses $60-$75 BILION A YEAR! Which one is a better value to tax payers?
11 Dec 2024 2:30 pm
According to estimates from the National Health Care Anti-Fraud Association, Medicare fraud costs taxpayers over $100 billion annually, though some sources like the Senior Medicare Patrol place the figure closer to $60 billion a year; this represents a significant amount of fraudulent activity within the Medicare system.EDC4ALL! » 11 Dec 2024, 3:27 pm » wrote: ↑ Medicare pay's bills when they are presented. You are correct! This is why their is so much fraud in Medicare and Medicare doesn't really check because they DONT FREAKING CARE. It's not THEIR money!
Medicare loses billions of dollars each year due to fraud, errors, and abuse. Estimates place these losses at approximately $60 billion annually, though the exact figure is impossible to measure.
And here you claim that tax payers are getting ripped off by Advantage plans....
Funny how PRIVATE PART C PLANS are able to avoid so much of this THEFT, huh, but it's a "rip off" according to Cletus.
Liberals are spoiled children, miserable, unsatisfied, demanding, ill-disciplined, despotic & useless. Liberalism is a philosophy of sniveling brats ~O'Rourke
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
11 Dec 2024 2:56 pm
Only proves that big pharma is in on the scam!!! Just like with the vaccines...*Beekeeper » 11 Dec 2024, 3:25 pm » wrote: ↑ Really??
I can show you a CLAIM for a PART B drug that is over $6,000 PER INJECTION and the Medicare Advantage plan FULLY approved it's use.
And the Part B claim on that WOULD have been 20%, or $1200 PER INJECTION and there can be from 4-6 per YEAR that are needed.
So try to explain your **** when the FACTS don't line up!!
https://i.postimg.cc/JhtbP0JB/Dismissed-Evidence.jpg
11 Dec 2024 2:58 pm
He doesn't!!! That is why he became and ER doctor 25 years ago.
11 Dec 2024 3:05 pm
Buffalo » 11 Dec 2024, 3:56 pm » wrote: ↑ Only proves that big pharma is in on the scam!!! Just like with the vaccines...
I won't disagree with you there. I'm clean!
11 Dec 2024 3:05 pm
Buffalo » 11 Dec 2024, 3:58 pm » wrote: ↑ He doesn't!!! That is why he became and ER doctor 25 years ago.
How do you know the people that are doing his billing don't?
11 Dec 2024 3:06 pm
Buffalo » 11 Dec 2024, 3:58 pm » wrote: ↑ He doesn't!!! That is why he became and ER doctor 25 years ago.
BTW, thanks to your brother. I've made many an ER trip since 1960!
11 Dec 2024 3:28 pm
The wife has been billing health insurance for 30+ years so she knows quite a bit but when it comes to Medicare, we cal Stan the Man. He has been an excellent advocate and we could care less how much he got paid.EDC4ALL! » 11 Dec 2024, 3:02 pm » wrote: ↑ Since ALL the plans cover the same as far as medical goes, I use a different system. 1) what doctor/system do you use now, and what doctor/system might you want to use in the future. (are you a snowbird?). This is followed CLOSELY by what drugs you are taking. Sometimes if a person is taking an expensive drug, one company may cover that better than the rest. If you are taking tier 3 & 4 drugs, it's usually better to have a plan that has set copays not co-insurance. ( this is a % of an unknown dollar amount). 3rd/4th is customer service and agent support. Sometimes a smaller more local company will have much better customer support. They might sell in a smaller area just in you State, so they can't piss people off with crappy overseas call centers, lose business, and make it up in another State.
Companies that don't have their own agents, tend to treat their agents better by giving us fast support and help fix customer problems quicker. The bells and whistles (dental, vision, otc) are the LAST thing that you consider. They ALL offer some, and if one plan has a big dental benefit, they had to take that money from other places. United (biggest company of all) has very good customer service and since (at least in Wisconsin) they don't have any agents, they really help independent agents with any problems that MIGHT arise. The star rating is somewhat of an indicator of quality (5 star is best), but as long as its a 4.5 star it's ok.
Suppose you could spend countless hours comparing plans and really not get anywhere on your own.
11 Dec 2024 3:43 pm
Oh, he knows its. The computer coding does it automatically.EDC4ALL! » 11 Dec 2024, 4:05 pm » wrote: ↑ How do you know the people that are doing his billing don't?
11 Dec 2024 3:46 pm
Buffalo » 11 Dec 2024, 4:43 pm » wrote: ↑ Oh, he knows its. The computer coding does it automatically.
so nobody eles in his department enters anything????
12 Dec 2024 4:39 am
Buffalo » 11 Dec 2024, 3:56 pm » wrote: ↑ Only proves that big pharma is in on the scam!!! Just like with the vaccines...
No, that's not the case here. When this injection is only applicable to a very small percentage of the population, the development costs MUST be spread over a much smaller number of sold items.
If you require $2 billion to research and develop a new line of cars, then only build 5,000 of them, that $2 billion is spread over a MUCH smaller number of cars than if you build 1,500,000 of them. WHY you idiots can't seem to fathom how that same principle applies to drugs is totally a statement of how **** INDOCTRINATED you losers in life really have become.
Liberals are spoiled children, miserable, unsatisfied, demanding, ill-disciplined, despotic & useless. Liberalism is a philosophy of sniveling brats ~O'Rourke
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
12 Dec 2024 5:18 am
How "**** INDOCTRINATED" you are and don't even know it!!! The taxpayers fund most research and development of new drugs, then big pharmas get to rip the taxpayers off for big profits. Big pharmaceutical corporations have become richer than big oil since the corona virus scam.*Beekeeper » 12 Dec 2024, 5:39 am » wrote: ↑ No, that's not the case here. When this injection is only applicable to a very small percentage of the population, the development costs MUST be spread over a much smaller number of sold items.
If you require $2 billion to research and develop a new line of cars, then only build 5,000 of them, that $2 billion is spread over a MUCH smaller number of cars than if you build 1,500,000 of them. WHY you idiots can't seem to fathom how that same principle applies to drugs is totally a statement of how **** INDOCTRINATED you losers in life really have become.
"It turns out that U.S. taxpayers are the ones that are not only funding that upstream basic science research that make all drug discovery possible, but are actually funding the invention of a substantial portion of new drugs," lead author Rahul Nayak, MD, told STAT."
Many New Drugs Benefit from Taxpayer-Funded Research | ASH Clinical News | American Society of Hematology
12 Dec 2024 5:30 am
Uh, no taxpayers DO NOT fully fund most R&D for drugs. The facts are it's roughly a 50/50 "split" of the $1-2 BILLION PER DRUG to get it to the actual consumer.Buffalo » 12 Dec 2024, 6:18 am » wrote: ↑ How "**** INDOCTRINATED" you are and don't even know it!!! The taxpayers fund most research and development of new drugs, then big pharmas get to rip the taxpayers off for big profits. Big pharmaceutical corporations have become richer than big oil since the corona virus scam.
"It turns out that U.S. taxpayers are the ones that are not only funding that upstream basic science research that make all drug discovery possible, but are actually funding the invention of a substantial portion of new drugs," lead author Rahul Nayak, MD, told STAT."
Many New Drugs Benefit from Taxpayer-Funded Research | ASH Clinical News | American Society of Hematology
Opinion: Who Really Pays for Drug Development? Both Government and Industry - BioSpace
Once AGAIN, you make a claim WITH ZERO EVIDENCE to support it. Someones OPINION isn't a fact. The NUMBERS I PRESENTED ARE!!
Liberals are spoiled children, miserable, unsatisfied, demanding, ill-disciplined, despotic & useless. Liberalism is a philosophy of sniveling brats ~O'Rourke
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
12 Dec 2024 5:38 am
So, you think a 50% subsidy of taxpayer money to fund research and development that big pharmas then profit $BILLIONS from is appropriate?*Beekeeper » 12 Dec 2024, 6:30 am » wrote: ↑ Uh, no taxpayers DO NOT fully fund most R&D for drugs. The facts are it's roughly a 50/50 "split" of the $1-2 BILLION PER DRUG to get it to the actual consumer.
Opinion: Who Really Pays for Drug Development? Both Government and Industry - BioSpace
Once AGAIN, you make a claim WITH ZERO EVIDENCE to support it. Someones OPINION isn't a fact. The NUMBERS I PRESENTED ARE!!
I do not!!!
He who pays the piper, calls the tune.What's the connection between sky high drug prices and the millions that Big Pharma spends on lobbying to protect its profits? How much do pharmaceutical CEOs make? How much is spent on blocking reforms that would make drugs and healthcare affordable to millions of Americans? Where do the political donations go? Follow the money with this relationship map.
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