Dirty Tactics of Those Medicare Advantage Plans

Once again we were saved from another Medicare cut at the last minute. This is really getting old. The only consolation is that for once it is getting more press coverage than in the past, mostly with the (correct) slant that these cuts will ultimately hurt Medicare beneficiaries. Several Republican senators changed their votes from their previous positions on HR 6331 to yes after receiving a lot of flack from their constituents, many of them physicians.

Someone (a Fox News follower) said, “There must have been a reason that those senators voted against it.” Well, yes, apparently there was. It seems that without those cuts to physicians the cuts would have been to Medicare Advantage programs, and this would affect “seniors’ access to privatized health care.” After all, we don’t want “socialized health care”, do we? [Note: Socialized health care = Medicare]

This is another example of why physicians should be careful about blindly voting along party lines. Neither of the major parties is necessarily going to do what is in the best interests of the practice of medicine.

So, in effort to control runaway health care costs, the government wants to “privatize” Medicare by paying Medicare Advantage plans a premium to manage costs by cutting physician reimbursement. That makes a lot of sense.

And just to give you an idea of what these companies are like to deal with, let me tell you about one dirty tactic in particular: the Health Plan Update.

(First let me preface this by saying that we use a consultant to negotiate all of our managed care contracts – and if you email me I can give you the info – and even he was surprised by this method)

The health plan company will send you a Health Plan Update which may state that your new reimbursement will be 10 or 20% less than what it states in your contract. At the bottom of the letter it reads: If you do not submit in writing your objections to the plan update [within 30 days], you are essentially agreeing to the proposed action.

The real dirty part is that this letter can be addressed to the practice, one of the doctors (looks like junk mail), the administrator, or the business office. So if the letter is accidentally thrown away, you just approved a cut in your reimbursement schedule – Congratulations!