Asclepios Your Weekly Medicare Consumer Advocacy Update
Who Are You Going to Call? July 3, 2008 ; Volume 8, Issue 27 If you break your hip, do you call an orthopedic surgeon, or an insurance executive? Who do you trust to read your chest X-ray, your cardiologist or an insurance broker? Would you rather have a physical therapist or a private equity manager help you recover from a stroke? The vote last week by 39 senators against the Medicare Improvements for Patients and Providers Act jeopardizes the access people with Medicare have to doctors and other health care providers. This vote, against a bill that passed the House of Representatives with broad, bipartisan support, allows a 10.6 percent Medicare pay cut to take effect. It also imposes a $1,810 cap—with no exceptions allowed—on rehabilitation therapy. Patients recovering from stroke may face an abrupt halt in treatment because they are near or over their quota for treatment this year. The Medicare Improvements for Patients and Providers Act, HR 6331, also helped guarantee access to providers for enrollees in private fee-for-service (PFFS) plans, Medicare private health plans that operate without a network of providers. PFFS plans are not subject to the same oversight by the Centers for Medicare & Medicaid Services (CMS) as other types of Medicare private health plans. No one at CMS makes sure these plans provide adequate access to specialists and other providers before they are marketed. That means these plans can be sold in parts of the country even if no cardiologist, orthopedic surgeon or other specialist in the area will take the plan. HR 6331 would have required, over time and in areas of the country where other companies have established provider networks, that PFFS plans also set up networks that meet minimum access requirements. The insurance companies that sell these plans, and their cheerleaders in the White House, however, are opposed to this new protection for consumers. PFFS plans are a money-making bonanza, reaping payments for insurance companies that average 17 percent above comparable costs under Original Medicare. These plans do not need to establish networks, provide care coordination or report on the quality of care their members receive. The government is barred from reviewing the benefit packages offered by PFFS plans to ensure that taxpayers and enrollees are getting their money's worth. The vote against HR. 6331 last week was a vote to protect the special rules and exemptions that make PFFS plans so lucrative for insurance companies, even though it jeopardized access to care for people with Medicare. The senators who voted "No" last week will get a chance to vote again next week. Tell them they need to make the right choice. Call 1-866-622-2184 to connect toll-free to the Capitol Switchboard. Ask for your senator's office and tell your senator to cast a vote for HR. 6331 and for people with Medicare. You can also write and urge your senator to vote for HR. 6331. Medical Record "I signed up for a Medicare Advantage Private-Fee-For-Service plan in June 2006 for $84 per month. The brochure from the insurance company sounded great with all the co-pays. My doctor would not accept the insurance and told me no doctor in town would! To see for myself, I called doctors. My doctor was right. I had to pay for visits out of pocket. I called the insurance company's customer services 6 to 8 times to find a doctor who would take my insurance. In December 2006, I called CMS to tell them I did not want this insurance company for 2007 nor any thing connected to them. I now have a drug plan with the same insurance company that I did not want. I had too much trouble with them, but CMS is pushing the insurance." (Story submitted to the Private Health Plan Monitoring Project (http://www.kintera.org/TR.asp?a=llI5IlM1JmI1KqJ&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIWH) from Walnut, MS, March 2008) "An estimated 700,000 Medicare beneficiaries will exceed the limit on their Medicare therapy benefit this year. These beneficiaries, the majority of whom reside in skilled nursing facilities, will suffer if the exception process is not maintained. Many of these beneficiaries are currently in the process of receiving needed care and were receiving such care on June 30th when the exception expired. With the exception process, their Medicare therapy benefit will end."(Baucus Fights To Protect Seniors' Access to Therapy Services Under Medicare (http://www.kintera.org/TR.asp?a=eeKRJ0NzHfLOI6I&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIWH), July 2008) Senate vote to invoke Cloture on the Motion to Proceed on HR. 6331 fell short of the 60 votes needed. Yea votes indicate support for passage of HR. 6331. No votes indicate opposition. Majority Leader Harry Reid, Democrat of Nevada, voted No to preserve the right to bring the bill up for a vote again. (Roll Call vote on HR. 6331 (http://www.kintera.org/TR.asp?a=jjJ1LfPTIlIQKcJ&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIWH), June 2008) * * * * Medicare Part D Appeals Help for Advocates is here! MRC's new Medicare Part D Appeals: An advocate's manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources. Download a FREE copy (http://www.kintera.org/TR.asp?a=ddKPIXMvHfLFLVI&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIWH&af=y) of this great resource. * * * * Medicare Part D Monitoring Project The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a Medicare private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed. Submit your story at http://www.medicarerights.org/partdstories.html. (http://www.kintera.org/TR.asp?a=ggIVI6OHJiJMJ5L&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIWH &af=y) * * * * The Louder Our Voice, the Stronger Our Message Asclepios —named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today (http://www.kintera.org/TR.asp?a=jjK1JfPTLlITLfK&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIWH&af=y). * * * * The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care. Visit our online subscription form to sign up for Asclepios at http://www.medicarerights.org/subscribeframeset.html (http://www.kintera.org/TR.asp?a=mwL7KoM5KoL0JpJ&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIWH&af=y). To unsubscribe from this mailing, please go to http://www.kintera.org/TR.asp?a=hrLXJ9PLJnKVKbL&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIWH To modify your profile and subscription preferences, please click go to http://www.kintera.org/TR.asp?a=kuJ3KiMXLqJ2IlK&s=orJZK6OBL9LSK1PKE&m=cgLMI1PzEbIW H **************Gas prices getting you down? Search AOL Autos for fuel-efficient used cars. (http://autos.aol.com/used?ncid=aolaut00050000000007)
