Monday July 31, 2023

A free public service for a better community

Happy Monday Healthcare Advocates

I would like to encourage comments and suggestions from you if you have time. If there is a special topic you’d like to see please let me know. Please use the comment button below. Some of the topics in work are funding for key medical research, rural healthcare, and healthcare in prison.

Happy Birthday Medicare

Happy Birthday Medicare. Yesterday it turned 58. Prior to Medicare seniors who needed healthcare were SOL. Medicare is also single handedly responsible for desegregating medical facilities and hospitals in the US. The only way it could be made better is to make it available for all of us, get rid of the copays and deductibles, limits and preauthorizations, add vision, dental and hearing and cover us all cradle to grave. Oh yes, that’s either HR 3421 of S. 1655.

ACTION

Let’s let our Representative in Congress and our Senators know we want universal healthcare. Trust me they need to hear this over and over until they believe their jobs are at stake. You can find their contact info here.

Or use RESISTBOT on your cellphone by sending a text message. Text to 50409 SIGN PWPHAK to send this message.

I am your constituent. and I wanted to send you a message to say Happy Birthday Medicare. It turned 58 on July 30th. Prior to Medicare seniors and health care were SOL. Medicare is also single handedly responsible for desegregating medical facilities and hospitals. The only way it could be made better is to make it available for all of us, get rid of the copays and deductibles, limits and preauthorizations, add vision, dental and hearing and cover us all cradle to grave. So I want you to actively support Medicare for All OF US. That’s HR 3421 or S 1655.

ITS NOT MEDICARE - ITS Medicare Advantage (Part C)

I can’t tell you how many people I run into who tell me they have Medicare (public insurance paying private providers) and aren’t happy. What they really have is Medicare Advantage (Part C). They are often shocked to see that they have networks to abide by, they have to have a referral to get to a specialist and lots of headaches. This was put together years ago as a privatization of Medicare and a giveaway to the private insurance companies.. The Center for Medicare and Medicaid Services (CMS) administers the program and pays $1000/month to private insurance companies for each person they sign up. If they code you with something “serious” they can collect hundreds a month more. It is by far the most profitable health insurance for sale in the US. In fact, some companies have stopped selling other insurance and now only sell these plans to retirees.

Ads on TV sound like your getting Medicare but what they are selling is Medicare Advantage.

Here are some of the problems:

1. The require pre authorizations and can have significant denials. We’ll discuss denials below.

2. They also insert copays where you might least expect it, like in hospitalization (Medicare Part A).

3. They have super high overhead rates. Medicare (public insurance paying private providers) is about 2% of claims. Private insurance averages about 15% and can go well over 20%.

4. While monthly premiums may be cheaper than some Medigap plans monthly premiums, when intensive and expensive care is needed, prior authorizations, co-insurance, copays and out-of-pocket maximums to be paid can make these MA plans a real disadvantage to some enrollees.

5. Confusing the consumer to sign up for these makes insurance companies richer and costs the consumers far more.

There is a new bill in front of Congress and it would prohibit using the word Medicare when selling Part C (Advantage) plans. It is HR 732. Here is a really cute TV ad describing what the bill proposes. Part C plans will be called Alternative Private Health Plans.

ACTION

Let’s tell our Congressional Representatives and Senators that enough is enough. Stop letting insurance companies trick people into getting Medicare Advantage instead of Medicare with misleading ads. Make them call the plans they are selling Alternative Private Health Plans. Pass HR 732, the Save Medicare Act. You can find their contact info here.

Or use RESISTBOT on your cellphone by sending a text message. Text to 50409 SIGN PJVXHY to send this message.

I am your constituent and I am tired of seniors being tricked into Medicare Advantage plans when they think they are getting Medicare. I want you to support and pass HR 732, the Save Medicare Act, that will relabel Medicare Advantage Plans as Alternative Private Health Plans. An informed consumer can make better choices. Help them.

Health Insurance Claim Denials

If you are having claims denied - we have resources below for appealing the denials. Some states will even help you by arranging a third party review for you.

Several readers have asked me to find out what the claims denial rate is for health insurance in their state. HHS collects that data for “Alternative Private Health Plans (I’m getting into to - Medicare Part C) and for Medicaid. They also collect that data for Affordable Care Act plans in over 30 states.

I will report on those later this week but here is a preview. Most ACA plans have an average denial rate of 18% of submitted claims (80% are overturned on appeal - but many of us don’t appeal). Many plans are as low as 3% denial, some as high as 49%. Cigna uses software to deny claims at the rate of about 300,000 in 2 months using automated software and are being sued for it in California.

Anyway, if we knew the denial rate of the insurance we were buying we might choose a low rate. Here is a good Washington Post story on the subject.

Back to the request from readers. I tried to get the information in Washington State. The Insurance Commissioner’s office refused. I sent the equivalent of a “Freedom of Information Request” and they claimed they could not release the data (they do have it).

One reader asked me to get the data for Utah. I called the Insurance Commissioner and had the data in 2 days.

My task this week will be to ask the other 48 states. I will put the information together in a spreadsheet and share it here. Ok, more later. Have a good day, Advocates and thanks for taking action!!!

Find My Elected Officials

Contact the White House  https://www.whitehouse.gov/contact/

Contact State and Federal Representatives

https://www.commoncause.org/find-your-representative/addr/

Important Healthcare Resources

League of Women Voters Healthcare Reform Toolkit

Our Newsletter resources including reproductive healthcare

Healthcare Advocacy Reading List

Organizations to Contact

National Nurses United Medicare4All

Physicians for a National Health Plan

Reproductive Health

NARAL - Pro Choice America

Planned Parenthood

Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.

United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.

Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.

If you need financial help with an abortion try abortionfunds.org

Claims Denials and Appeals & What to Do

Appeal a Healthcare Decision

Appeal/Negotiate a Hospital Bill

Save Democracy

Chop Wood, Carry Water by Jessica Cravens

RESISTBOT

Link to the RESISTBOT site to learn more

Link to Chop Wood, Carry Water Resistbot write up