Just thought that I would stir the MAPD vs MS pot again: Start at 2:25

[sshafran]

some denials do happen. the bigger systemic issue, by far, and probably ultimately harder to rein in, is the enrollee health status gaming

Are you referring to things like HRAs and other data collection methods to try to indicate that health is worse than it is? Incentivizing clients to think of any health conditions so that they can get a $50/mo grocery card (and the insurer makes more $$).

It's a racket.

Carriers in the MAPD market love a sick(er) enrolee -- more $.

They're just as bad as a doctor who sees a slight shadow on their imaging machines...ready to pounce.

 

[AgentGeneral]

Are you referring to things like HRAs and other data collection methods to try to indicate that health is worse than it is? Incentivizing clients to think of any health conditions so that they can get a $50/mo grocery card (and the insurer makes more $$).

It's a racket.

Carriers in the MAPD market love a sick(er) enrolee -- more $.

They're just as bad as a doctor who sees a slight shadow on their imaging machines...ready to pounce.

I agree

I was also wondering about them loving or hating more sick individuals. I am old school and still stuck on feeling a little bad about sending them someone so sick I know theyll cost the carrier a ton. Guess that's part of my insurance upbringing. There was a time I'd only leave the office for an appt with a TIP TOP healthy client for U65, LI, DI, CI etc.

Still feels weird to me enrolling uber unhealthy.

Good to know. lol.

 

[policywonk]

I agree

I was also wondering about them loving or hating more sick individuals. I am old school and still stuck on feeling a little bad about sending them someone so sick I know theyll cost the carrier a ton. Guess that's part of my insurance upbringing. There was a time I'd only leave the office for an appt with a TIP TOP healthy client for U65, LI, DI, CI etc.

Still feels weird to me enrolling uber unhealthy.

Good to know. lol.

lol - i started in the medicare health plan biz in the early nineties and yes it use to a bad sign if you walked in a home and tripped over an oxygen tube .

 

[Duaine]

Straight from the HORSES Mouth:
[EXTERNAL LINK] - I worked for CMS. Even I struggle to help family navigate dual eligibility