United Healthcare House Calls - Consequences of Denying Them

[ImThinkin2019]

I have been on United Healthcare Medicare Advantage for about a year.

They keep calling me to set up a home visit for a wellness check.

Asked my primary care doc if it was worth it and he said they have less tools than he does so his exams are more thorough.

Plus I prefer as much privacy regarding my health as possible.

Based on this I called them back yesterday and asked them to take me off the call list. I do not want the service.

The rep was very pushy, obviously incentived to get me to accept the home visit including the cashback reward card. I still opted out. Will see if it sticks.

Does anyone know why they are pushing this? And has anyone successfully got them to stop? Know any consequences of not doing the home visits?

[Pellice]

Someone told me that the home care visits are reimbursed to the company by Medicare.

I've had them twice. If you have a good physical from your GP, they are less useful. If your GP visits are hurried, 10 minute things, maybe. I liked that they did a test for peripheral arterial disease, which was what took my father. Had my first cognitive test (what were those 3 words??) But I declined this year because I had several visits with my GP. And I agree, I felt they were pushy.

[audreyh1]

Not on Medicare. Last few years I get calls annually from BCBSTX for a home visit for a “checkup”. I explain that I already get annual checkups with my PCP and go to them for anything I need. They are pretty pushy.

Regardless I’m not interested in having the insurance company “nurse” take my vitals or anything. And certainly not visit my home. It’s intrusive.

[orchid55]

I think that I read on a previous thread about these visits that the companies are looking to diagnose you with more conditions and thus be reimbursed for your care by Medicare at a higher rate.

[audreyh1]

Looks like quite a racket! https://www.google.com/search?client...bih=1023&dpr=2

[Teacher Terry]

I would let those calls go to voicemail so you don’t have to deal with it.

[RetMD21]

I liked this article from Audrey's search:

Medicare Home Invasion
https://www.medicaleconomics.com/vie...home-invasions

[Ian S]

Definitely a racket. They get a lot of extra money from the government if they can show your have some chronic even if insignificant aliments. It's all about "risk scores."

[Spock]

Same with the insurance online "wellness surveys" in exchange for a $50 debit card. None of this is done out of the goodness of their heart. I figured they're building a database for pre-existing condition denials or other data mining where they can pick out some AI-generated trend to put you into some other risk group or social credit score if you drink/smoke/eat wrong.

[Gotadimple]

Quote:

Originally Posted by Spock Same with the insurance online "wellness surveys" in exchange for a $50 debit card. None of this is done out of the goodness of their heart. I figured they're building a database for pre-existing condition denials or other data mining where they can pick out some AI-generated trend to put you into some other risk group or social credit score if you drink/smoke/eat wrong.

Or justify to a state insurance department or to the Federal government (CMS, Medicaid, Federal Employee Plan) why they need a higher reimbursement rate than the other companies.

[Irishgirlyc58]

Although the people posting here don’t have a need for an in home visit, there are many seniors who can benefit from this practice.
Some people are much more isolated than others and visiting at home is a good way to assess the person’s environment and identify issues that may not be as apparent in a doctor’s office visit.
People can pull it together for that 15-30 minute office visit. At home not so much.
A visit could result in a referral to social services- adult services which can lead to other services being offered.
When I was working- health and human services- we would actually sometimes get alerted by animal control. They would go out due to a complaint from neighbors and notice somethings were questionable.
I actually think it’s a great idea. You just never know who will benefit from the practice.

[MichaelB]

I was unaware Medicare Advantage plans could get increased reimbursement by manipulating the risk profile of their policyholders. It does explain a lot.

My DM has a United HealthCare Medicare Advantage plan, which I manage for her. She got 2-3 calls per month for about 2 years, which never made it past the initial authentication. The caller would ask me for personal identifying info, I’d respond they were the ones that called the phone number of record and the burden of proof was on them, and there the call ended.

Finally one caller did agree to speak with me. She said the purpose of the visit was to identify insured members with chronic conditions that might benefit from more carefully coordinated care by a team of “select providers”. I interpreted this as 1) chronic care costs more than half of all insurance reimbursements, 2) UHC wants to limit that cost, 3) the “select team” had lower contract reimbursement rates than average, and 4) if they found such need they would attempt to convince the policyholder to use their select providers for ongoing care and treatment.

This identification of chronic conditions also supports the risk level / reimbursement rate.

In a way, it’s also an attempt to create HMO like conditions for someone enrolled in a PPO

[RetMD21]

Quote:

Originally Posted by MichaelB This identification of chronic conditions also supports the risk level / reimbursement rate.

It's a win-win-win for the insurance. Their contractor can use the Medicare wellness code which looks good since it is underutilized. They can look for more diagnosis codes to get the higher reimbursement. There is no co-pay for the wellness code so the patient won't mind. The payment for the wellness visit partially or fully offsets the cost of the visit. They tell the patient that they are doing this because they care. They tell their agents that they have a higher rate of wellness visits than traditional Medicare.

[athena53]

Quote:

Originally Posted by MichaelB I was unaware Medicare Advantage plans could get increased reimbursement by manipulating the risk profile of their policyholders. It does explain a lot. <snip> Finally one caller did agree to speak with me. She said the purpose of the visit was to identify insured members with chronic conditions that might benefit from more carefully coordinated care by a team of “select providers”. I interpreted this as 1) chronic care costs more than half of all insurance reimbursements, 2) UHC wants to limit that cost, 3) the “select team” had lower contract reimbursement rates than average, and 4) if they found such need they would attempt to convince the policyholder to use their select providers for ongoing care and treatment. This identification of chronic conditions also supports the risk level / reimbursement rate. In a way, it’s also an attempt to create HMO like conditions for someone enrolled in a PPO

There are a couple of features of this that aren't all bad. Since Advantage plans pay the insurer a lump sum per insured, they should be getting more $$ for the ones with health issues. (And yes, I know that companies have gotten in trouble for fraudulently rating people as higher risk to get more money.)

I can also see them wanting to be more involved in managing those with ongoing issues. They might even be able to prevent expensive complications by making sure they're taking meds, etc. I live in a town of 30,000 with somewhat poor demographics and we have 2 dialysis clinics that I know of. Closer management of Type 2 diabetes might prevent kidney failure.

Having said that- I share the skepticism of most here with regard to Advantage plans. I had a home visit when I first signed up for an ACA plan after retiring at 61 and it was pretty rudimentary.

[Gotadimple]

Quote:

Originally Posted by athena53 There are a couple of features of this that aren't all bad. Since Advantage plans pay the insurer a lump sum per insured, they should be getting more $$ for the ones with health issues. (And yes, I know that companies have gotten in trouble for fraudulently rating people as higher risk to get more money.) I can also see them wanting to be more involved in managing those with ongoing issues. . . . Having said that- I share the skepticism of most here with regard to Advantage plans. I had a home visit when I first signed up for an ACA plan after retiring at 61 and it was pretty rudimentary.

All good points. And many managed care plans offer to send a doctor for a home visit like United Health Care does.

But we're talking about UHC here, one of the biggest and oldest MA health plans in the U.S. They have all kinds of data from their members they can use to justify an increased rate from CMS. They pioneered data mining so they could identify cases where a case manager was needed to help manage care and keep claims costs down. MA plans are now required to have case management in place before they are awarded a CMS contract.

I think this is more about current income generation than upcoding diagnoses codes. I have a MA plan and have been offered this service before, and declined. It is intrusive. Certainly, if I was not happy with my doctor, I might consider it as a free second opinion, but I'm not sure it's worth the effort.

[grayv]

someone could try asking for $50 to allow the house call.

[SecondAttempt]

Quote:

Originally Posted by Irishgirlyc58 Although the people posting here don’t have a need for an in home visit, there are many seniors who can benefit from this practice. Some people are much more isolated than others and visiting at home is a good way to assess the person’s environment and identify issues that may not be as apparent in a doctor’s office visit. People can pull it together for that 15-30 minute office visit. At home not so much. A visit could result in a referral to social services- adult services which can lead to other services being offered. When I was working- health and human services- we would actually sometimes get alerted by animal control. They would go out due to a complaint from neighbors and notice somethings were questionable. I actually think it’s a great idea. You just never know who will benefit from the practice.

Here in Hawaii, a while ago, probably precovid, at least one health insurer was touting home visits as a way to assess conditions to improve health for the elderly. They mentioned things like were there exposed roots that could be a trip hazard. These were radio ads touting a "benefit." I'm cynical enough to believe the ill-intent expressed here but also willing to accept that there may be a genuine medical benefit to assessing home conditions in many cases.

[Z3Dreamer]

Was travelling in DC recently. Heard a radio ad for UHC MA that touted the House Calls as a benefit if you sign up for their MA plan.

I have a UHC MA plan and I had a House Call. For me, it was a waste of a good professional's time (She was a nurse practitioner.) But for some, I can see it being useful. Or it could be a scam by the insurance company to get more revenues (for those who hate MA's).

[RetMD21]

Quote:

Originally Posted by Z3Dreamer Was travelling in DC recently. Heard a radio ad for UHC MA that touted the House Calls as a benefit if you sign up for their MA plan. I have a UHC MA plan and I had a House Call. For me, it was a waste of a good professional's time (She was a nurse practitioner.) But for some, I can see it being useful. Or it could be a scam by the insurance company to get more revenues (for those who hate MA's).

I don't hate MA but they do get paid more if they can find more diagnoses for their patients. I am doubting that their are just altruistic.

[Irishgirlyc58]

Quote:

Originally Posted by RetMD21 I don't hate MA but they do get paid more if they can find more diagnoses for their patients. I am doubting that their are just altruistic.

Oh I don’t for a minute think that for profit organizations do anything out of the kindness of their hearts. [emoji1785]
However, sometimes you take the bad parts to get the good parts.
Home visits are a proven best practice in seeing issues- health, mental health, domestic abuse, etc. So I do see the benefits of these HV.
If you see 20 people and identify issues with 2 that’s a big success. To me the bigger question is what are the services/ care provided once issues are identified. What’s the follow up. Where are the outcomes.
I’m more interested in that.