Medicare Robo Call Madness

[Hermit]

Like the other thread, I get annoying and repetitive calls only in this case on behalf of my Medicare Advantage agent (Humana) multiple times a week wanting to do an "in-home health and well-being assessment". It ain't gonna happen! I don't need a snoop telling me how I need to live or taking pictures "for their files". I don't respond to these calls. This has been going on for at least two years.

Do all Medicare recipients get these calls?

 

[Teacher Terry]

Not 65 until July but that’s weird. The last time I went to the doctor the medical assistant asked a few questions and one was am I sexually active. I thought that was odd.

 

[misanman]

Like the other thread, I get annoying and repetitive calls only in this case on behalf of my Medicare Advantage agent (Humana) multiple times a week wanting to do an "in-home health and well-being assessment". It ain't gonna happen! I don't need a snoop telling me how I need to live or taking pictures "for their files". I don't respond to these calls. This has been going on for at least two years.

Do all Medicare recipients get these calls?

I think this only happens with Medicare Advantage. The assessment is used to justify the fee that the insurance company is paid by the government. To the extent that the insurance company can identify medical conditions they will be paid more.

 

[HtownRose]

My Mom has a MA plan & we've never gotten a call like that. We get plenty of spam calls though & I keep meaning to see what can be done about it, think I saved a link from a previous thread.

Usually the calls, if we answer them at all, go something like this.

Caller sounds like they are in a call center from all the background noise & they have an unfamiliar accent. They ask for my mom & say they are calling from "Medicare." When questioned - what do you mean - you're with the government? my Medicare insurance company? the Medicare agent? - they hang up.

 

[gayl]

I think this only happens with Medicare Advantage Humana

 

[Scrapr]

can you press 9 to take you off the robocall list? There are a couple numbers to try. ( is one I think, also 2

I did engage with an "agent" this week. I started asking questions before he could start in on his spiel. I ask his name. Ask him to spell it. Ask him where he is right now. I found out his favorite baseball player from the Dominican Republic is Sammy Sosa. I called Sammy a cheater. Our engagement ended soon after

 

[swakyaby]

I have been getting these kinds of calls twice a week. One for DH, one for me, always from Blue Shield, our insurance carrier. The same robocall voice says she has important healthcare information, but first must verify our identity. She then asks for my date of birth. I then hang up. The same voice calls back a week later explaining the need for this verifying information to make sure that they re speaking to the correct person. I tell the robocaller to mail the information to me, to take me off their calling list, and hang up. It doesn’t seem to work. DH and I still get those calls every week, 8:00 am, 5 pm, and 7:00 pm.

 

[swakyaby]

Interestingly, these sophisticated robocalls started occurring only 2 years ago, around the same time frame as the Medicare Advantage robocalls some posters have mentioned. Two weeks ago, the annoying Blue Shield robocalls seemed to stop. But they seem to have been replaced by a robocall from a woman who identifies herself as a promotional gift organization, and immediately asks if I can clearly hear her. Instead of saying “yes,” I say “ I can hear you.” The female robocaller immediately disconnects. This is the 3rd time I received this call in 2 weeks.

 

[athena53]

The last time I went to the doctor the medical assistant asked a few questions and one was am I sexually active. I thought that was odd.

In answer to the OP- been on Medicare since 1/1, not Humana, nit Medicare Advantage. No calls.

I read recently that 17% of new STD cases are in seniors. When I told my doc last year that I was in a relationship she promptly asked if I needed to be tested for STDs. (It was monogamous, so, no.) There's also a dreadfully expensive prescription that can make sex less painful for post-menopausal women and maybe the doc wanted to see if that was needed.

 

[grasshopper]

Not 65 until July but that’s weird. The last time I went to the doctor the medical assistant asked a few questions and one was am I sexually active. I thought that was odd.

I would only find it weird if the next question was "are there any guns in your house?"

 

[scrabbler1]

It isn't Medicare, but in October and November I was getting bunches of robocalls from "Ann from Health Care Hotline" or something similar, telling me about all these great deals they can get me from HI companies. Ann got around, apparently. One day all the calls would come from New Jersey, then the next day from Arizona, then the next day from Illinois, etc.

 

[Walt34]

I don't get these calls but I'm not on an advantage plan either. I'm still in my former employer's BCBS group insurance plan, now secondary to Medicare.

We also have a call blocker that works very well so it may be blocking those calls and I just don't know it.

 

[Hermit]

I found a letter from Humana extolling the virtues of an in-home review so I think they are lagitamate. They do things like blood preasure and weight along with the home inspection. Maybe my doctor won't give them that info so they are trying to get it this other way. They seem to confuse insurance agent with doctor. I'll stick to having them take care of the billing side and I will work the health side with the doctor.

 

[athena53]

I had a similar visit at the beginning of one of my ACA policies. There seems to be a trend towards coding these discussions separately so the practitioners can charge for them even though there are no medical complaints involved. And, I suppose that 1 out of every 100 times, the nurse on one of these visits actually convinces someone to make changes for good- losing weight, getting high BP checked out, etc.

 

[Gotadimple]

I have gotten these calls from my Medicare Advantage plan - but not twice a day or even twice a week. There must be a new requirement by Medicare that the MA plans offer this extra independent physician review, for which they (the plan and the independent doctor) will be compensated. I assume it fulfills a quality assurance requirement they have with Medicare.
As to the robocalls. Hang up, then get your insurance card, turn it over and call customer service. Tell them you want off their robocall list. Leaving a message in response to the robocall won't work as they are pre-qualifying you before connecting you to a customer service agent. If that doesn't work, contact your state insurance commissioner

 

[Pluperfect]

I think this only happens with Medicare Advantage. The assessment is used to justify the fee that the insurance company is paid by the government. To the extent that the insurance company can identify medical conditions they will be paid more.

If you're interested in this topic, I recommend a 30-minute show I saw the other day on PBS:
https://www.pbs.org/video/medicare-advantage-taking-advantage-aldeae/

It explains how Medicare Advantage insurers get paid, and how they make money, and how they make more money if they have sicker insureds, and how they get insureds reclassified into the higher-paying categories, behind the insureds' and doctors' backs.

I'm not in love with any insurance company, but this sure left a bad taste in my mouth when it comes to the major players in Medicare Advantage.

 

[Gotadimple]

If you're interested in this topic, I recommend a 30-minute show I saw the other day on PBS:

It explains how Medicare Advantage insurers get paid, and how they make money, and how they make more money if they have sicker insureds, and how they get insureds reclassified into the higher-paying categories, behind the insureds' and doctors' backs.

I'm not in love with any insurance company, but this sure left a bad taste in my mouth when it comes to the major players in Medicare Advantage.

Substituting diagnosis codes, charging for home medical equipment that was never delivered, showing encounters with a physician when there was no visit: typical fraud found in both Private, Traditional, and Medicare Advantage codes. If MA has a 10% improper payment rate, Private and Traditional Medicare plans' improper payment rates are even higher.


Having worked for an insurance carrier who had both programs, your tax $ are safer with MA than with Traditional Medicare because CMS doesn't start an investigation under Traditional Medicare unless the combined total of suspected fraud is in 6 figures.



Unfortunately, this is fact of life in the insurance business. Focusing on MA is misdirection - Private insurance and Traditional Medicare have many more holes in the fraud prevention methodology. Fraud comes not generally from insurers, but mostly from providers.

 

[Pluperfect]

Fraud comes not generally from insurers, but mostly from providers.

But what the report revealed was the fraud perpetrated by the Medicare Advantage insurers to increase the amount Medicare pays them for each insured, which is different from and in addition to the fraud by providers. Medicare Advantage offers an extra layer of opportunity for fraud, one that the insurers exploited quickly and effectively.

I'm troubled by having my tax dollars going to an insurance company that has a financial incentive to present me to Medicare as being sicker than my own doctor has diagnosed me, and that will engage in sketchy tactics to get my doctor to help them do it.

People's mileage may vary on this, but it never hurts to be informed.

 

[Hermit]

But what the report revealed was the fraud perpetrated by the Medicare Advantage insurers to increase the amount Medicare pays them for each insured, which is different from and in addition to the fraud by providers. Medicare Advantage offers an extra layer of opportunity for fraud, one that the insurers exploited quickly and effectively.

I'm troubled by having my tax dollars going to an insurance company that has a financial incentive to present me to Medicare as being sicker than my own doctor has diagnosed me, and that will engage in sketchy tactics to get my doctor to help them do it.

People's mileage may vary on this, but it never hurts to be informed.

IMHO, I think the MA insurers would watch for fraud from providers like a hawk because that is money out of their pocket.

 

[Gotadimple]

Here is how payments work between CMS, the plan, and the provider:


Ifyou pay $134 a month for Medicare Part B, the government pays a large amount to the health plan (i.e. $120), and the health plan contracts with providers and pays them a significant portion to provide care and take the risk (i.e. $100). So if it costs more than $120 (or $100) to provide care - too bad. That's the issue with MA, the plan and the provider need to be safely comfortable they can operate on the monthly fee.



The issue as described in the program was that some carriers upcode claims to justify the extra increase in monthly stipend from CMS. About 10% of the time some carriers upcode and CMS has been able to recover less than 1% of the fraudulent billings.


So this isn't about claims - it's about premiums. Why isn't CMS more successful at spotting upcoding and even more - why are they ineffective at collections?