easy wind
Member
May have been the other thread where it was asked ´how does MA save the gov’t $?’
It does so exactly by denial of claims, which plain gubmint Medicare would have paid.
MA then denies the claims that are supplemental to medicare to save themselves money too.
Besides the premiums collected up front, MA contracts with all the providers to pay them less than medicare would (in addition to tons of paperwork not required by medicare). MA collects in full from medicare for said service and then pockets the contractual difference PLUS keeps the part of the medicare reimbursement which you paid in copays to the provider. Slick scheme, unlikely to change much.
Basically it is not pharmacy benefit managers alone who are the ‘middlemen’, it is the entire MA system. Still better than nothing.
I go to countries where there is socialized medicine, people have medical cards too, there just aren’t any providers or servicers to receive care from. The way it is going here with how insurance treats providers and with 26% of our docs being foreigners already (usually educated in their home country for free), there will be fewer docs willing to play the insurance game (or to take on the debt of school). It is already hard to find a medicare doc available in our rural area because they have to limit their financial exposure to the lowest paying / highest time burden group to a small percentage of the practice. Cash pay is available here at least. Unless you need a hospital which won’t do surgeries as cash due to the complication risk of further care and likely burden of eventual financial loss.
So do all the ´things’ to stay healthy because insurance doesn’t kill you, but injury and disease can, regardless of any type of Cadillac coverage.
It does so exactly by denial of claims, which plain gubmint Medicare would have paid.
MA then denies the claims that are supplemental to medicare to save themselves money too.
Besides the premiums collected up front, MA contracts with all the providers to pay them less than medicare would (in addition to tons of paperwork not required by medicare). MA collects in full from medicare for said service and then pockets the contractual difference PLUS keeps the part of the medicare reimbursement which you paid in copays to the provider. Slick scheme, unlikely to change much.
Basically it is not pharmacy benefit managers alone who are the ‘middlemen’, it is the entire MA system. Still better than nothing.
I go to countries where there is socialized medicine, people have medical cards too, there just aren’t any providers or servicers to receive care from. The way it is going here with how insurance treats providers and with 26% of our docs being foreigners already (usually educated in their home country for free), there will be fewer docs willing to play the insurance game (or to take on the debt of school). It is already hard to find a medicare doc available in our rural area because they have to limit their financial exposure to the lowest paying / highest time burden group to a small percentage of the practice. Cash pay is available here at least. Unless you need a hospital which won’t do surgeries as cash due to the complication risk of further care and likely burden of eventual financial loss.
So do all the ´things’ to stay healthy because insurance doesn’t kill you, but injury and disease can, regardless of any type of Cadillac coverage.
