Sunday, July 01, 2012

United Health Care Dual Complete HMO SNP: Medicare Advantage Plan Disguising Itself as Medicare

So, I'm looking at the letter from United HealthCare to a client of mine (providers get a different set of explanations, ya know).  This is a long term client of mine who switched from standard Medicare to United HealthCare, a reportedly 'Medicare Advantage Plan' (they have an administration rate of 15% + while regular standard Medicare has an administration rate of 5%: go figure) about six months ago and I sent a complaint to the NC Insurance Commissioner re: the sleight of hand associated with they not paying me as I was 'out of network.' 

She has since switched back to standard Medicare . And so when I sent the complaint re: non-paid charges to the NC Insurance Comissioner, they called me, indicated it was 'being investigated by Medicare' and assumeably I am to be paid.

I've been a Medicare provider for over 10 years.   These plans are 'supposed' to simulate Medicare. 

But they obviously do not.

So, I researched her plan, which is described in her letter from United Health Care as the following plan:

"......This is a Medicare Advantage plan for people on Medicaid who also qualify for Medicare – commonly known as "dual eligible." It's intended for people who live in a community setting, receive financial help (such as SSI) from their State Medicaid program and have Medicare. This plan includes all Medicare Part A (Hospital) & B (Doctor) benefits and Part D prescription drug coverage. It also provides benefits not offered by Original Medicare.
This plan is available in the following counties: Alamance, Buncombe, Caswell, Catawba, Chatham, Cumberland, Davidson, Davie, Durham, Forsyth, Guilford, Haywood, Henderson, Mecklenburg, Orange, Person, Randolph, Rockingham, Rowan, Stokes, Surry, Wake, Wilkes and Yadkin.
Call Us at 1-800-905-8671 or let us call you (TTY# 711 for hearing impaired) 7 days a week from 8:00 a.m. to 8:00 p.m. local time...."

In looking at her letter which is associated with paying me my Medicare Provider fee, it states the following interesting information:

1. "Plans are insured or covered by an AFFILIATE of UnitedHealthcare Insurance Company, a Medicare Advantage Organization with a Medicare contract and a Medicare-approved Part D sponsor."

OH, so we're at the level of 'an affiliate.'  This basically means, re: this sleight of hand, that the 'affiliate' can act as an HMO which indicated to me in errors codes as my biller attempted to recoup my charges, that I was 'out of network', which, of course, is an HMO ploy.

My client indicated that she had wanted nothing to do w/ HMO's/ PPO's re: all our collective information associated with the debacles of in/ out network brouhahas.

My, what a tangled web we weave.


Blogger said...


Unlike Medicare, There are NO Deductibles with a Dual SNP!
And few to none with a simple MA plan.
Medicare is cutting services, especially oncology, but this is not the case with MA plans..

12:46 PM  

Post a Comment

<< Home