Health Care Scams and Frauds

You’d think that when you got to be older that things would settle into an easy and pleasant routine. Instead, seniors are subject to more scams than ever, including health care cons.

Whatever happened to the time when seniors were revered and held in great esteem? When they were the history and our legends, and stood for progress? When they fought for us to make this nation great and free and lived to tell those battle stories? What happened in the 21st century is recession, lives lived longer than ever, escalating health care costs, and a total confusion about what Medicare and Medicare supplements offer. What happened are insurance companies ripping off unsuspecting seniors because they can.

Why prey on seniors? The answer to that is easy. Preying on seniors is like shooting fish in a barrel. They’re there, they have no place to go and sometimes no family support, usually have money saved up for a small nest egg and aren’t technologically savvy or that aware of what goes on around them, especially if they have cognitive difficulties.

Seniors have become “easy” targets for scammers and schemers and insurance companies who would rather rip them off than make sure they have what they need in terms of proper health insurance. Unfortunately, it is incredibly easy to take advantage of some seniors. Consider this; ALL seniors are on Medicare of some sort, but asking them how their policy works usually draws a blank stare.

Start asking them questions about whether or not there is a deductible for parts A through D and they don’t know if they pay one or not. Is there anything better in terms of a Medicare Supplement plan other than alphabet letters A through L? Again, many elderly people don’t know the answer. Ask if their Medicare Advantage plans (soon to be extinct) cost more by way of co-pays and deductibles than it really saves on their premiums, and once again, they are not sure.

Most seniors are aware of the news about health care reform and their major concern is whether or not their plans will be taken away and how to keep paying for them if the price goes up. That is the focus of America’s seniors – will they lose their plans, what will replace them and how much will it cost. It’s not much of a wonder why a senior on a limited budget would jump at the chance to save money on health insurance if it were offered to them. It would be easy for someone to say, “You can save a lot of money with my plan.”

The point to be made is that there is a great deal of confusion over the existing Medicare system, over what will happen to it and about what will replace it or improve it, or not. Unfortunately there are scam artists lurking out there, dressed in insurance broker clothing, who are more interested in making money from uninformed and confused seniors. For example, there have been cases where seniors had Medicare Supplement plans and were enrolled in the Advantage plan, which is illegal.

There are also cases of elderly people being invoiced twice for the same co-pay amount and paying it because they thought they should. Was the double billing unintentional or not? It could have been double billed on purpose, as Medicare fraud is at an all time high.

Are there solutions to situations like this or are the system and the people in it doomed to be ripped off? With more attention to education about health care and health insurance and looking out for one another, there is hope. Our finances are personal and need to be protected. People need to get wise and get articulate about their health insurance. Knowledge is indeed power.

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What’s a Health Care Cooperative?

Right now, the only “public” option for affordable health insurance is Medicare, which is only for those over 65 years old. If there isn’t another “public” option for others, this has ramifications for Medicare and Medicaid.

Right now in the U.S. there is a single payer government plan, Medicare, for those over the age of 65. The plan works as well as it can, given the debt load of the nation and the spiraling costs of health care. There isn’t anything else like this idea for other people who can’t afford health care or can’t afford much coverage at all. This is where health care reform is supposed to come in.

The clear problem with health care reform that doesn’t have a government option or component is that those who aren’t in Medicare or Medicaid may wind up raiding those programs to get what they need. That may mean a decrease in funding and greater difficulty in accessing programs for those over 65; a sort of Robin Hood approach of robbing the richer programs to pay for the poorer programs.

The substitution of the so-called health care cooperative for the government option is simply a thinly veiled excuse for the creation of more insurance companies. The usual example trotted out of a health care cooperative is something called Group Health. In fact, Group Health is an “insurance” company that reinvests its yearly revenues not redistributes them among members. It is only governed like a cooperative, making it one in name only.

Group Health’s fees are a tad lower than other insurance outfits, records are computerized and physicians get performance based salaries which seems to be a code word for “keeping costs down to a minimum.”
To access affordable health care by this route, those needing medical assistance are assigned a team of primary care practitioners, meaning you have no say in the matter. If access isn’t readily available to see the doctor, you will see a nurse; no ifs, ands or buts. If keeping medical costs down is the raison d’être for the insurance company, chances are expensive tests are not ordered that often and treating deathly ill patients would not be a preference.

Drugs and procedures, how medicine is practiced, and health insurance coverage decisions are made by the company – made by an insurance company. Think about that for a minute. Reading between the lines here, Group Health isn’t really “group health,” it is an insurance company with a bottom line to stay in business and make money. Staying in business by cost cutting medical care is a scary idea.

Will this come to pass? Only time will tell, and since the health care reform bill is gathering some dust right now, no one seems to know what will transpire for the future. For now Medicare and Medicare supplements are doing yeoman’s duty and allowing people the choice of physicians. It may not be perfect, but it limps along, working for “now.” Stay tuned for what the future may bring, and in the meantime do some thinking about what alternatives might work for your health care. The President has said if people like their health care they can keep it. Can they?

Clelland Green is with Benepath.com, a leader in providing health insurance quotes. Benepath provides individuals, families, and businesses with affordable health insurance quotes in just a few mouse clicks. To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.

Major Issues Still Remain with Health Care Reform

While it sounded like a good plan to have health care reform on the go by Labor Day, the deadline came and went. What’s next?

Next is what the House chooses to do when they sit in September. Some of the ridiculous issues raised over the summer months have up and gone away, but others remain that will likely be a great deal more contentious and have greater ramifications.

The leading issue seems to be the “public plan,” which is a polite way of speaking about a kind of government insurance plan that would be available to those who had absolutely no other health insurance options. While this sounds like a dandy plan on the surface, there are those that insist it would be a government takeover of health care, not always a good thing given the current state of affairs.

On the other side of the fence there are those that make the case that the public plan is ultimately necessary for any kind of reform to be effective. If access to health care is an issue that is supposed to be resolved, then this particular point of view tends to make sense to a large number of people.

Taking a step backward to get a clearer view of the debate, one comes to the conclusion that both sides of the argument have a point, but neither is totally right. That isn’t too much of a surprise given that it’s politicians doing the infighting. Really, the questions that ought to be asked, rather than focusing on poverty and access to health care, might be, “How will the government make Medicaid better and stronger?”

This question makes sense since the original universal health care changes have been tanked for now and the focus shifted to expanding health insurance coverage to certain segments of the population. Obviously, one of those segments is people living in poverty. Everyone should have a safety net for medical expenses, and there isn’t one right now. Instead, families face potential bankruptcy and total financial ruin over medical bills.

Ironically, the one program that should be able to help those in such dire circumstances – Medicaid – doesn’t guarantee either insurance or health care to people in poverty. Reform, if it is indeed on its way, needs to perhaps have Medicaid returned under the federal government’s wing and change the reimbursement doctors are given so they may assist people in poverty. That would make a significant change in the health care system.

If poorer people did have access to health care, it would keep them from having to use hospital emergency rooms. Just think about how much this one small change would mean to the system wide budget that faces escalating costs, thanks to poor people using ERs as doctor’s offices.

Clelland Green is with Benepath.com, a leader in providing health insurance quotes. Benepath provides individuals, families, and businesses with affordable health insurance quotes in just a few mouse clicks. To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.