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Promises Broken
Dallas’ Channel 8 News reported July 7, 2008, that 62 percent of Texas doctors say they will refuse to take new Medicare patients if Congress fails to revoke the July 2008 Medicare cuts to physicians. Here in Waxahachie, this comes as no surprise because several local physicians already refuse to take new Medicare patients.
So, let’s see if I can get this straight. We the People pay for Medicare, from payroll taxes and deductions from Social Security benefits, but, if we don’t have a physician who’ll take traditional Medicare, we’re out of luck. Yes, that’s about right . . .
Promises Broken.
Why cut payments to physicians?
Here’s my take. I suspect that cutting physician payments (again) is a ploy to move people out of traditional Medicare and into Medicare Advantage.
How does that work? If there are no physicians willing to take Medicare, then beneficiaries are forced to turn to private insurers that use physicians who have agreed to work within their plan. Will these be the most competent physicians available? Or will they be the ones who put the interest of the insurer first?
Why would Medicare want to do that? Two possibilities arise.
First, Medicare reports that many people with supplemental coverage are overusing Medicare services. Moving beneficiaries into Medicare Advantage plans relieves some of the burden on Medicare to provide promised services.
Second, because private insurance companies run Medicare Advantage plans, Medicare itself is relieved of some of the administrative expenses. That’s good for Medicare, but may not be so good for those of us shunted into plans that promise one thing but deliver something different.
In June 2007, seven Medicare Advantage plans suspended their marketing efforts “voluntarily” because there were many complaints of discrepancies between what prospects were told plans would do and what the plans actually did. The seven resumed marketing the following September, assuring Congress and Medicare that future marketing would be less aggressive and more realistic.
On the surface, Medicare Advantage plans offer more benefits to consumers than does traditional Medicare. Do the Advantage plans follow through on those benefits? I have direct experience with only one plan, but it was a doozy. I won’t be doing it again.
A real horror story
We enrolled my 89-year-old mother in a Medicare-approved plan in November 2006. The sales agent promised the following:
• Mom could continue to use her present physician, including all the laboratory services, and the plan would not only cover all services but also inform her physician of the change in her plan.
• Mom would have full coverage at our local hospital. Because we have only one hospital in town, that was a critical consideration.
We learned soon after the plan began that her physician knew nothing of the change. He agreed to continue to see her only because she was a long-time patient.
Promises broken.
We learned within a couple of months that our local hospital would not accept the plan, and that four years ago they went on record as refusing to accept any Medicare Advantage plan. Clearly, the sales agent was promising what could not be delivered.
Promises broken.
We learned that the plan refused payment to Mom’s physician because they said she was not covered by the plan. This happened in spite of the fact that we had a signed policy and that the plan was debiting her bank account for monthly premiums as well as accepting payments from Medicare.
Promises broken.
Within the specified disenrollment period, we sent a registered letter disenrolling her from the plan. Our letter was ignored. Our next six registered letters were also ignored. However, we eventually got a letter from the plan that stated that because she’d already used her single change option (demanding to disenroll), she could not disenroll. After six months, we asked our Congressman to intervene, and he was able to resolve the situation. The plan agreed to disenroll her and refund her premiums for the period when she should have been disenrolled. The refund never arrived.
Promises broken.
My story may sound extreme, but after learning that Congress had to act to force termination of such underhanded practices, I believe that it is not unusual.
How can you avoid a similar situation?
Before you agree to join any plan, do the following:
1. Talk to three or more people who’ve been in that plan for at least one year. Find out what their experiences have been.
2. Take the policy to your legal advisor so you’ll understand your rights and benefits under the plan. Do not take the word of a salesperson – for anything!
3. Call the billing department of your preferred hospital to learn which, if any, Advantage plans they accept.
4. Assume that Medicare and Medicare Advantage plans will continue to reduce benefits and raise premiums. So, begin to take full responsibility for your own health.
We are fortunate in having access to a world of good health information on the internet. Use it to keep your good health and to learn about any condition that may develop. You can do much to improve your health and avoid promises broken.
UPDATE: July 9, 2008
Medicare bill reversing cuts in physician payments has passed the Senate by two more votes than needed to override a Presidential veto.
While this bill has reversed the cuts to physicians, it has also underlined the need for seniors to become personally responsible for their own health. Could it happen again? No doubt in my mind.
UPDATE: July 15, 2008
President Bush vetoed this bill, and Congress voted to override his veto. Payments to physicians will be not be cut for the next 11 1/2 month therefore physicians who accept Medicare patients will probably continue. However, don’t kid yourself. This is an election year, so Congress is eager to please its constituents who vote. Next year, there is no election, so . . .