somarco

GA Medicare Expert
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Atlanta
In letters sent Monday to CMS officials, the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) pointed to a coverage policy for inpatient hospital care distributed by UnitedHealthcare and set to go into effect Jan. 1.

That policy “blatantly violates” coverage criteria revisions included in the calendar year 2024 MA final rule that prohibit MA plans from limiting or denying coverage for hospital services that would be covered under traditional Medicare, FAH President and CEO Chip Kahn said in a statement accompanying his organization’s letter to CMS.

“Among other concerns, UHC continues to use proprietary software that unlawfully narrows MA beneficiaries’ inpatient hospital benefits, creating patient care risks as well as higher cost-share burdens,” Kahn said. “Medicare beneficiaries should not be shortchanged by UnitedHealthcare or any MA plan. We have flagged UnitedHealthcare’s unlawful policies for CMS and pledge to work with the Agency to ensure Medicare’s coverage policies for all of America’s seniors.”



https://www.fiercehealthcare.com/pa...tantly-violates-new-cms-coverage-requirements
 
Just got a call from a frantic wife at hosp, husband 81 on uhc mapd and is in urgent need of acute phys therapy. All 3 doctors state its necessary. The uhc panel denied it a 2nd time. "What can she do as she starts to cry? Why can't he get a med supp? Shouldn't that be illegal?"

Mapd agents. What do I tell her except appeal appeal appeal?
 
Just got a call from a frantic wife at hosp, husband 81 on uhc mapd and is in urgent need of acute phys therapy. All 3 doctors state its necessary. The uhc panel denied it a 2nd time. "What can she do as she starts to cry? Why can't he get a med supp? Shouldn't that be illegal?"

Mapd agents. What do I tell her except appeal appeal appeal?
Tell her it's fake news and scare tactics. That should make her feel better.
 
I have never received one

Almost sounds made up, eh?
20 a year from non clients? Why the hell would they call if not a client. You would think I would get at least 100 then since I have several hundred on MA. Still waiting by the phone.
 
I just can't believe that mapd agents don't get these type of calls. I get 20 a year and they are not my clients.

I don't get that many . . . maybe 5 - 10 or so, but I do get calls from folks on MAPD who want to change. If these folks are not calling their agent there is obviously something lacking in the relationship . . .
 
Almost sounds made up, eh?
20 a year from non clients? Why the hell would they call if not a client. You would think I would get at least 100 then since I have several hundred on MA. Still waiting by the phone.

Because all my clients love their med supps, and when a family or friend complains about mapd, they refer to me. Can't stop happy clients from wanting to help sorry mapd victims.
 
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