Insurer's 'wa$te' products
By JAMES FANELLI
The New York Post
It's enough to make you sick.
A federally subsidized health insurer is wasting tax dollars, hawking overpriced medical supplies to its members that could be bought at a fraction of the cost online or in stores.
Private insurer Evercare doles out about $50 worth of "benefit credits" every three months to its plan members and sends them a catalog from which to pick the items. The items include everything from a first-aid kit to over-the-counter painkillers to exercise equipment.
One example of the unhealthy spending is a Nexcare Reusable ColdHot Pack. Evercare lists the price at $20 in its catalog, but the same item can be bought online from medical-supply distributor JRS Medical for $12.27.
"It's a rip-off," said a Murray Hill retiree and Evercare plan member. "I could walk into Jack's 99 Cent Store on 40th Street and get these things cheaper . . . It's the reason why the government is losing money."
Evercare is a Medicare Advantage plan, a privately run insurance fund that receives hefty subsidies from Medicare. About 11 million Medicare recipients are enrolled in MA plans, and the federal government spent $109.7 billion on those plans in 2009. MA plans took off in the 1990s, when private insurers convinced the feds that they could provide cheaper coverage than Medicare and offer more benefits and perks with minimum premiums or none at all.
The plans initially saved the government about 5 percent on the average cost of a regular Medicare recipient. But now, the federal government spends 14 percent more on MA plans than regular Medicare. That equals about $849.90 in monthly subsidies per MA plan member, according to the Kaiser foundation, which focuses on health-care issues.
The federal health-care overhaul signed in March aims to make the costs of MA plans even with regular Medicare.
Matthew Burns, a spokesman for Evercare, said, "Our catalog pricing is competitive with most retail pharmacies and, unlike most online outlets, our pricing includes shipping charges."
jfanelli@nypost.com
Read more: http://www.nypost.com/p/news/local/insurer_wa_te_products_8LAMZjidS8ac1PA0GkAp0N#ixzz0rPW527OB
Showing posts with label .Tags: Patient. Show all posts
Showing posts with label .Tags: Patient. Show all posts
Sunday, June 20, 2010
Saturday, April 24, 2010
North Texas legislators seek tougher action against health care contractor Evercare
10:41 PM CST on Wednesday, February 11, 2009
By ROBERT T. GARRETT / The Dallas Morning News
rtgarrett@dallasnews.com
AUSTIN – North Texas lawmakers have urged the state to crack down on a health insurer that manages care of the area's 78,000 elderly and disabled Medicaid patients.
Republican Sens. Jane Nelson of Flower Mound and Chris Harris of Arlington said Wednesday that fines against Evercare of Texas haven't worked.
At a Senate Finance Committee hearing, both senators said that they still field many complaints from Evercare plan members who can't find doctors willing to see them.
"Citizens are finding it extremely difficult to find a provider," Nelson said.
Nelson, the Senate's chief health policy writer, recounted taking a call from a woman with a uterine tumor. The woman couldn't obtain treatment because no local gynecologist would sign a contract with Evercare, a unit of the giant UnitedHealth Group, Nelson said.
"We just don't seem to be getting anywhere," Nelson told Albert Hawkins, who runs Medicaid in Texas as head of the Health and Human Services Commission. "We've got to do something to fix it."
The problems that Texans have had with Evercare were the focus of a Dallas Morning News investigation last month.
Hawkins said he shares lawmakers' frustrations, though he stopped short of threatening to revoke the UnitedHealth subsidiary's $1.8 million-per-month contract.
An Evercare spokeswoman said the company has made "significant progress" lately.
"There were challenges taking over this program from the state, but we continue to work aggressively to address each member's concern," said Beth Mandell, the company's regional executive director.
By ROBERT T. GARRETT / The Dallas Morning News
rtgarrett@dallasnews.com
AUSTIN – North Texas lawmakers have urged the state to crack down on a health insurer that manages care of the area's 78,000 elderly and disabled Medicaid patients.
Republican Sens. Jane Nelson of Flower Mound and Chris Harris of Arlington said Wednesday that fines against Evercare of Texas haven't worked.
At a Senate Finance Committee hearing, both senators said that they still field many complaints from Evercare plan members who can't find doctors willing to see them.
"Citizens are finding it extremely difficult to find a provider," Nelson said.
Nelson, the Senate's chief health policy writer, recounted taking a call from a woman with a uterine tumor. The woman couldn't obtain treatment because no local gynecologist would sign a contract with Evercare, a unit of the giant UnitedHealth Group, Nelson said.
"We just don't seem to be getting anywhere," Nelson told Albert Hawkins, who runs Medicaid in Texas as head of the Health and Human Services Commission. "We've got to do something to fix it."
The problems that Texans have had with Evercare were the focus of a Dallas Morning News investigation last month.
Hawkins said he shares lawmakers' frustrations, though he stopped short of threatening to revoke the UnitedHealth subsidiary's $1.8 million-per-month contract.
An Evercare spokeswoman said the company has made "significant progress" lately.
"There were challenges taking over this program from the state, but we continue to work aggressively to address each member's concern," said Beth Mandell, the company's regional executive director.
Friday, April 23, 2010
Texas Rescinds Contract With Evercare Medicaid Service in Dallas
As Published on BNET on March 19th, 2009
Evercare, a unit of UnitedHealth Group, is losing its contract to provide coordinated care services to more than 74,000 elderly and disabled Medicaid patients in North Texas. The Texas Health and Human Services Commission terminated the contract, effective May 31, after many patients complained that they were having trouble accessing medical services through Evercare. Patients who are in the Evercare program will return to traditional Medicaid or a local Medicaid HMO.
Evercare, which operates in seven states, employs nurse case managers who are supposed to coordinate preventive and chronic care for patients and guide them through the health care system. (Evercare also runs Medicare Advantage plans and has a palliative care and hospice division.) The company, which has received some national awards, claims that its efforts reduce hospital admissions by 40 percent.
Since February 2008, Texas has been paying Evercare $1.8 million a month, expecting that improved care management would save $110 million over two years by reducing ER visits and hospitalizations. What happened instead is that the Health and Human Services Commission received complaints from hundreds of patients who said they were unable to get the services they had been promised. For starters, many doctors on Evercare’s provider list told patients that they were not part of its network. Some patients had to wait months for dental work or for someone to coordinate their care. Over the past year, Texas has fined Evercare over $1 million for various deficiencies, including its failure to ensure that care was provided in a timely manner.
The Dallas Morning News quotes Beth Mandell, regional executive director for Evercare of Texas, as saying that, in North Texas, the integrated care model “proved complex, often making it challenging to provide timely service to members.”
What seems to be missing in the news accounts is the difficulty of getting physicians to accept Medicaid patients. Especially in Texas, where doctors receive above-average reimbursement from private insurers, both Medicaid and Medicare pay poorly by comparison. This is a problem that is going to get worse as states grapple with the economic crisis and their growing budget gaps.
That doesn’t let Evercare/United off the hook. It’s hard to understand how a health plan or a care management company could enroll people—let alone vulnerable, ill seniors—without having an adequate network in place first. We can only hope that this scenario won’t be replayed, with Evercare and similar firms, in other areas across the country.
Ken Terry, a former senior editor at Medical Economics Magazine, is the author of the book Rx For Health Care Reform. follow all BNET Healthcare posts on Twitter.
Evercare, a unit of UnitedHealth Group, is losing its contract to provide coordinated care services to more than 74,000 elderly and disabled Medicaid patients in North Texas. The Texas Health and Human Services Commission terminated the contract, effective May 31, after many patients complained that they were having trouble accessing medical services through Evercare. Patients who are in the Evercare program will return to traditional Medicaid or a local Medicaid HMO.
Evercare, which operates in seven states, employs nurse case managers who are supposed to coordinate preventive and chronic care for patients and guide them through the health care system. (Evercare also runs Medicare Advantage plans and has a palliative care and hospice division.) The company, which has received some national awards, claims that its efforts reduce hospital admissions by 40 percent.
Since February 2008, Texas has been paying Evercare $1.8 million a month, expecting that improved care management would save $110 million over two years by reducing ER visits and hospitalizations. What happened instead is that the Health and Human Services Commission received complaints from hundreds of patients who said they were unable to get the services they had been promised. For starters, many doctors on Evercare’s provider list told patients that they were not part of its network. Some patients had to wait months for dental work or for someone to coordinate their care. Over the past year, Texas has fined Evercare over $1 million for various deficiencies, including its failure to ensure that care was provided in a timely manner.
The Dallas Morning News quotes Beth Mandell, regional executive director for Evercare of Texas, as saying that, in North Texas, the integrated care model “proved complex, often making it challenging to provide timely service to members.”
What seems to be missing in the news accounts is the difficulty of getting physicians to accept Medicaid patients. Especially in Texas, where doctors receive above-average reimbursement from private insurers, both Medicaid and Medicare pay poorly by comparison. This is a problem that is going to get worse as states grapple with the economic crisis and their growing budget gaps.
That doesn’t let Evercare/United off the hook. It’s hard to understand how a health plan or a care management company could enroll people—let alone vulnerable, ill seniors—without having an adequate network in place first. We can only hope that this scenario won’t be replayed, with Evercare and similar firms, in other areas across the country.
Ken Terry, a former senior editor at Medical Economics Magazine, is the author of the book Rx For Health Care Reform. follow all BNET Healthcare posts on Twitter.
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