re: United Healthcare Buying People's Health

Also I am not arguing against requiring prior auth to keep some shitty PCP from jumping straight to ordering a MRI for someone who has a headache. I’m arguing about appropriate rehab care for people that qualify for it under all other reasonable insurances.

Skimping on services to make a profit= Managed Care

If I have gotten just 5 people's eyes opened on the whole "managed care" SCAM (Humana, Peoples, etc) situation, I'm going to bed happy! Tell all your family, friends and anyone approaching 65....JUST DON'T DO IT! STICK WITH MEDICARE FOR BETTER CARE!

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I’m arguing about appropriate rehab care for people that qualify for it under all other reasonable insurances.

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Yeah, I hear you. It’s frustrating to guide my family through the process sometimes and having to go through steps 1 and 2 to get to 3 (when we all know 3 is where we are headed anyway ) but I don’t blame it all on the medicare advantage plans. I know that’s how Humana keeps the patient cost as low as they do. Is the system perfect, no. But I’ve got four family members in my close family on two MA plans right now. One in slidell, two in Nola and one in BR. They vary in health from weekend tennis player to someone who’s just a shoe in for two in-patient stays a year. When faced with the choice of putting up with the process of prior auths or paying substantially more out of pocket for originals medicare, even though they chooose different plans, the choice was simple for each of them.

That being said, all of their docs already participated in the networks of the plans they joined.

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The physicians aren’t writing the checks, ergo they have no authority. Despite your protests, more and more facilities (including specialists) enter into risk sharing agreements with payors every month. Would this happen if they thought the HMOs were operating in bad faith?

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The rehab physicians aren’t writing the checks, but when a rehab physician does a consult on a patient in an acute care hospital, and recommends inpatient rehab, why deny it initially? Then the rehab doc has to do a peer-to-peer review with a semi-retired family practice doc from three states away, just to justify the rehab admission.

I understand if it’s something that falls in the 40% of the 60/40% rule of rehab admissions (like a unilateral total knee replacement), but with a stroke patient, it’s ridiculous.

This is correct. I sell a test which is covered by Medicare so it is $0 out of pocket for regular medicare patients. If the patient has a medicare advantage plan such as People's Health, etc the patient will then get a bill for $350 or more. I know many other examples of this. Sometimes these plans do more harm then good for the patient financially. Not to mention People's Health is terrible, they don't pay anybody.