Joe, Interesting observations. Did you notice that your description of the Medicare system's medical care "restrictions" and claims management, strikingly resemble the work comp system? Certainly the private equity/for-profit comp health care management/claims adjudication programs fit that description. As restrictive as your descriptions sound, my personal experience with Kaiser's Medicare Advantage program here in northern California is medically and financially outstanding.
Always interesting to hear your perspective, Steve. There’s no question that some entities are doing a very good job on Medicare advantage, Kaiser being a prime example. However, like in many situations, others are much more concerned about profits than people.
Regarding your question about similarities with the Worker’s Comp. system, no, I do not find a parallel here. When you look at the actual data regarding utilization review, appeals, and overturns, there is a striking difference between Worker’s Comp. and Medicare advantage. Namely, in the workers comp system, many more appeals are rejected than in Medicare advantage. This points to the well-known problems in the LA basin with slimy providers attempting to abuse the Worker’s Comp. system. Be well, Joe.
Joe, Interesting observations. Did you notice that your description of the Medicare system's medical care "restrictions" and claims management, strikingly resemble the work comp system? Certainly the private equity/for-profit comp health care management/claims adjudication programs fit that description. As restrictive as your descriptions sound, my personal experience with Kaiser's Medicare Advantage program here in northern California is medically and financially outstanding.
Always interesting to hear your perspective, Steve. There’s no question that some entities are doing a very good job on Medicare advantage, Kaiser being a prime example. However, like in many situations, others are much more concerned about profits than people.
Regarding your question about similarities with the Worker’s Comp. system, no, I do not find a parallel here. When you look at the actual data regarding utilization review, appeals, and overturns, there is a striking difference between Worker’s Comp. and Medicare advantage. Namely, in the workers comp system, many more appeals are rejected than in Medicare advantage. This points to the well-known problems in the LA basin with slimy providers attempting to abuse the Worker’s Comp. system. Be well, Joe.