Nashcat
Site Supporter
This might be of interest to our members that have a Medicare Advantage insurance plan. For the last year, I’ve been receiving phone calls from my health insurance carrier, asking if I would like to have a home health visit. It was explained that a “health professional” would come to my home and give me a free checkup, consisting of checking blood pressure, glucose levels, and general well being. Since I had recently had a doctor’s appt, I declined. At first, the calls sounded like they wanted to save me a trip to the doctor’s office, but now the calls have been more frequent and much more aggressive, with the caller asking for specific reasons that I wanted to decline. So, I decided to search the web to see if was happening tp others. Turned out, it wasn’t about my health, at all.
The calls are trying to raise my “Risk Score”. It seems that when you visit your doctor for a check-up, Medicare reimburses your insurance an agreed amount, based on your risk score. Patients with a higher risk score, create higher Medicare reimbursements for the insurance company. You won’t hear about it, and your doctor may not realize it, but you insurance company is bringing in more money from Medicare. Your premiums don’t change, your deductible doesn’t go up, but the insurance company profits.
How, you say? If the “health professional” asks an innocent question such as “How you doin’ today?” Anything that you mention, may be considered a symptom. Mentioning that the rain makes your knee hurt, or that the pollen is making your eyes water, could raise your risk score. The “health professional” makes a note, the company assumes your knees are shot and you need allergy testing, and your risk score goes up. They don’t tell you, they might never mention it to your doctor, but the next time you visit your doctor, your insurance will bill Medicare at a higher rate, due to the “possibility” of more tests required, each visit.
My insurance comany even mailed me a free “Pee-in-the-bottle” test kit, to “save me some money”. I guess it’s another method of fishing for a $ymptom.
Whatever you do, don’t complain about not being able to ride you bike, because of the weather. On your next visit to the doc, you may find yourself being billed for severe depression, or being involved in risky behavior.
I guess I need to be a little more polite when they call. I don’t want to find myself being treated for “Severe Agressive Behavior” at my next office visit.
Read more at this link.
Harvard’s explanation
Ride Safe (and healthy)
John
The calls are trying to raise my “Risk Score”. It seems that when you visit your doctor for a check-up, Medicare reimburses your insurance an agreed amount, based on your risk score. Patients with a higher risk score, create higher Medicare reimbursements for the insurance company. You won’t hear about it, and your doctor may not realize it, but you insurance company is bringing in more money from Medicare. Your premiums don’t change, your deductible doesn’t go up, but the insurance company profits.
How, you say? If the “health professional” asks an innocent question such as “How you doin’ today?” Anything that you mention, may be considered a symptom. Mentioning that the rain makes your knee hurt, or that the pollen is making your eyes water, could raise your risk score. The “health professional” makes a note, the company assumes your knees are shot and you need allergy testing, and your risk score goes up. They don’t tell you, they might never mention it to your doctor, but the next time you visit your doctor, your insurance will bill Medicare at a higher rate, due to the “possibility” of more tests required, each visit.
My insurance comany even mailed me a free “Pee-in-the-bottle” test kit, to “save me some money”. I guess it’s another method of fishing for a $ymptom.
Whatever you do, don’t complain about not being able to ride you bike, because of the weather. On your next visit to the doc, you may find yourself being billed for severe depression, or being involved in risky behavior.
I guess I need to be a little more polite when they call. I don’t want to find myself being treated for “Severe Agressive Behavior” at my next office visit.
Read more at this link.
Harvard’s explanation
Ride Safe (and healthy)
John
