Thanks for the video, Erik. It's amazing to me that anyone on TH-cam would put out a video advocating fraud. Also, as an example, when you go to shop auto and/or home insurance and you give the agent your name and address, they can look up everything about you and your current policies. I would think if companies can do that for auto/home, they can do it for health insurance. It's kind of scary.
I think everyone has their own values. Some believe in doing whatever it takes for a client, I guess... but if they are caught and can't help anymore clients... doesn't seem like a good strategy.
I made the switch to a supplement plan because my Advantage Plan administrator wanted to be the doctor rather than an insurer. Might work for some people, not me.
2 things: 1. We have had people try to ask us to lie and it always makes things awkward. We’re not here to lie 2. We have seen a few doctors upcode their patients into worse conditions without their clients knowing. This means they don’t have let’s say, chronic kidney disease, but their doctor has been saying they do to get more money. It then comes up on the underwriting and the patients are shocked. It is crazy the fraud that happens in all sectors of the medical industry
It's absurd. Working on a series around this. Agents (video 1) Insurance companies (Video 2) Hospitals and Providers (Video 3) Pharma (Video 5) Maybe more... 🙂
Your 2nd point is why I always read my after-action report from any doctor visit or hospital visit (I recently had a CT scan and an MRI). So far, so good. I also review the e-MSN every time I get the notification.
Given all the third party tracking of everything, I got a little concerned yesterday when my agent asked permission to access pharmacy records for the past 2 years. I went ahead and agreed but that may have been a mistake. I operated a cat spay/neuter and veterinary program for 10 years. ALL the prescriptions had MY name on them- antianxiety, high blood pressure, antibiotics, narcotics and so on. I filled these RX at big box stores to save money. I hope any underwriter looks past the name on the prescription to see the DEA number belong to a veterinarian!
Question, I turn 65 late 2025, I am American citizen living abroad, China. I do have a US address, it's not my home, it's my sons home. I use this address to receive mail and for my US drivers license. I have US bank account where I am receiving my SS benefits. How does this effect my Medicare and Medigap Plans. I am not looking for information about using any coverage here in China, healthcare here is very inexpensive. Looking for information to as will this complicate signing up and complicate my coverage in the US if needed.
What is your take on the statistic of 32% claim denials at United Healthcare for their advantage plans? Also on the killing of the United Healthcare CEO?
I hope this comment is coming from a place of sincerity. There are 2 separate issues here. 1. The 32% claim denial statistic is from a ValuePenguin article. The statistic is referring to ACA marketplace plans, not Medicare Advantage plans. The article and statistic have the disclaimer at the bottom, "Editorial note: The content of this article is based on the author's opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners." The article has removed the graph at the request of law enforcement. The article states it is using its own interpretation of Marketplace claims data from 2022. If there is a different, legitimate study that has the same conclusions, I would love to see it to be able to answer more appropriately. KFF has their own study looking at ALL Advantage plan claims for the same time (2022) and lists all denials. It is nowhere near 32%. www.kff.org/medicare/issue-brief/use-of-prior-authorization-in-medicare-advantage-exceeded-46-million-requests-in-2022/ My take on improper claim denials, meaning claims that are denied but should have been approved, whether on marketplace plans or medicare or any other arrangement is that they should not happen. I am also cognizant of the fact that there is error in the world, so the will always be there, but the hope is that improper prior authorization denials would be as close to zero as possible. So, my take on the 32% claim denials at United Healthcare for their advantage plans is that the statistic is not referring to their advantage plans and has been used incorrectly. The sourcing and methodology also leaves me questioning any ability to draw real conclusions. It is also being used as justification for the cold-blooded murder of someone, which leads me to your 2nd question. 2. The killing of the United Healthcare CEO I will always, with 100% conviction, condemn the cold-blooded murder of an individual. A homicidal maniac shot a man several times in the back while the victim was walking down the street. The murderer fled the scene, and is still at large. It seems to easy for people to dehumanize this person. The victim is a husband, father, son, neighbor, and friend. I do not know him. I do not know his thoughts and beliefs. But, I do know that shooting someone in the back at point blank range is terrible and I hope the murderer is located and goes through the proper legal process. The fact that there are people who are not only okay with this is, but celebrating this murder is appalling and makes me worried about those individuals, their understanding of how a society should function, and what our roles as human beings should be in that society.
I feel in today's world, the key word is blunt! As an honest agent, we can't sugar coat, we have to repeat multiple times, and ask if they understand just to CYA
Yes, lying on an insurance application is obviously a terrible idea, but I had some questions about your videos. Why don't you compare the various Advantage plans against each other? You had a very educational run down comparing expenses of the supplement plans with a generic Advantage plan for a specific procedure, but is this realistic if it doesn't take the risk of denials into account?
Here is a video on the real risk of denials: th-cam.com/video/ewH3TXydopc/w-d-xo.html As part of our licensing, we cannot share plan specifics on any given insurance company's advantage plans. For example, I can't say XYZ insurance company has a plan that costs this much and has these benefits. All I can do with those is keep them general and so I use averages. In order to share plan specifics, I'd need approval from CMS - the federal governing body over Medicare. That approval takes time and likely would not allow me to share my real opinions on the plans.
All boils down to risk. Insurance companies have to pay the costs somehow, and if people just jumped on supplement plans without every paying premiums, just when they got super sick, that puts the insurance companies in an impossible position. We are working on a video that goes over this in more detail.
@ thanks for the response. I understand an insurance co wouldn’t want to pay claims before they’ve collected many premiums, but isn’t it the same for all types of insurance?
You continue to amaze me with your blunt honesty. Good Job!
Appreciate you watching!
Thank you for being the open, honest and transparent information source that we ALL need.
Thank you so much for watching! 🤝
Thanks for the video, Erik. It's amazing to me that anyone on TH-cam would put out a video advocating fraud. Also, as an example, when you go to shop auto and/or home insurance and you give the agent your name and address, they can look up everything about you and your current policies. I would think if companies can do that for auto/home, they can do it for health insurance. It's kind of scary.
I think everyone has their own values. Some believe in doing whatever it takes for a client, I guess... but if they are caught and can't help anymore clients... doesn't seem like a good strategy.
Thanks!
Thank you so much!! You are way too kind!
Thank you for the Medicare information on fraudulent company, thank you Eddie
Thank you so much for watching! 🙏
@Theretirementnerds your welcome 🙏🏻
I made the switch to a supplement plan because my Advantage Plan administrator wanted to be the doctor rather than an insurer. Might work for some people, not me.
All for switching when it makes sense :)
Just against committing insurance fraud to make the switch.
Fraud has become a life style sadly in this country and it will not stop.
A few bad apples make things much harder for everyone else.
@@carmenanico2786 people are tired of being screwed by insurance companies. Maybe see it as a way to fight back.
2 things:
1. We have had people try to ask us to lie and it always makes things awkward. We’re not here to lie
2. We have seen a few doctors upcode their patients into worse conditions without their clients knowing. This means they don’t have let’s say, chronic kidney disease, but their doctor has been saying they do to get more money. It then comes up on the underwriting and the patients are shocked. It is crazy the fraud that happens in all sectors of the medical industry
It's absurd. Working on a series around this.
Agents (video 1)
Insurance companies (Video 2)
Hospitals and Providers (Video 3)
Pharma (Video 5)
Maybe more... 🙂
Your 2nd point is why I always read my after-action report from any doctor visit or hospital visit (I recently had a CT scan and an MRI). So far, so good. I also review the e-MSN every time I get the notification.
Best wishes to you in Utah from Minnesota, and thank you for posting and your channel.
Always love seeing your username and kind comments :)
@@Theretirementnerds 😍
Erik, another great and informative video. Thank you!
Appreciate your support so much! Thank you for watching!
Given all the third party tracking of everything, I got a little concerned yesterday when my agent asked permission to access pharmacy records for the past 2 years. I went ahead and agreed but that may have been a mistake. I operated a cat spay/neuter and veterinary program for 10 years. ALL the prescriptions had MY name on them- antianxiety, high blood pressure, antibiotics, narcotics and so on. I filled these RX at big box stores to save money. I hope any underwriter looks past the name on the prescription to see the DEA number belong to a veterinarian!
Yes. And it is fraud to lie that you reside at an address in a zip code that is maybe just a few miles from your actual residence.
Yep. Honesty is the best policy...
Question, I turn 65 late 2025, I am American citizen living abroad, China. I do have a US address, it's not my home, it's my sons home. I use this address to receive mail and for my US drivers license. I have US bank account where I am receiving my SS benefits. How does this effect my Medicare and Medigap Plans. I am not looking for information about using any coverage here in China, healthcare here is very inexpensive. Looking for information to as will this complicate signing up and complicate my coverage in the US if needed.
You'd likely end up needing to sign up for Medicare through the embassy or consulate.
What is your take on the statistic of 32% claim denials at United Healthcare for their advantage plans? Also on the killing of the United Healthcare CEO?
I hope this comment is coming from a place of sincerity.
There are 2 separate issues here.
1. The 32% claim denial statistic is from a ValuePenguin article.
The statistic is referring to ACA marketplace plans, not Medicare Advantage plans.
The article and statistic have the disclaimer at the bottom, "Editorial note: The content of this article is based on the author's opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners."
The article has removed the graph at the request of law enforcement.
The article states it is using its own interpretation of Marketplace claims data from 2022.
If there is a different, legitimate study that has the same conclusions, I would love to see it to be able to answer more appropriately.
KFF has their own study looking at ALL Advantage plan claims for the same time (2022) and lists all denials. It is nowhere near 32%.
www.kff.org/medicare/issue-brief/use-of-prior-authorization-in-medicare-advantage-exceeded-46-million-requests-in-2022/
My take on improper claim denials, meaning claims that are denied but should have been approved, whether on marketplace plans or medicare or any other arrangement is that they should not happen. I am also cognizant of the fact that there is error in the world, so the will always be there, but the hope is that improper prior authorization denials would be as close to zero as possible.
So, my take on the 32% claim denials at United Healthcare for their advantage plans is that the statistic is not referring to their advantage plans and has been used incorrectly. The sourcing and methodology also leaves me questioning any ability to draw real conclusions.
It is also being used as justification for the cold-blooded murder of someone, which leads me to your 2nd question.
2. The killing of the United Healthcare CEO
I will always, with 100% conviction, condemn the cold-blooded murder of an individual. A homicidal maniac shot a man several times in the back while the victim was walking down the street. The murderer fled the scene, and is still at large.
It seems to easy for people to dehumanize this person.
The victim is a husband, father, son, neighbor, and friend.
I do not know him. I do not know his thoughts and beliefs.
But, I do know that shooting someone in the back at point blank range is terrible and I hope the murderer is located and goes through the proper legal process.
The fact that there are people who are not only okay with this is, but celebrating this murder is appalling and makes me worried about those individuals, their understanding of how a society should function, and what our roles as human beings should be in that society.
It should be a two way street though. Insurance plans are evil in their deceptive techniques, but we are supposed to just let go and accept it.
If you don't want underwriting choose a supplement at 65 or you move out of your advantage plans coverage area. Either way be honest.
You are absolutely right! Honesty is always the best policy.
4:43 what was that
I feel in today's world, the key word is blunt! As an honest agent, we can't sugar coat, we have to repeat multiple times, and ask if they understand just to CYA
Yes, lying on an insurance application is obviously a terrible idea, but I had some questions about your videos. Why don't you compare the various Advantage plans against each other? You had a very educational run down comparing expenses of the supplement plans with a generic Advantage plan for a specific procedure, but is this realistic if it doesn't take the risk of denials into account?
Here is a video on the real risk of denials:
th-cam.com/video/ewH3TXydopc/w-d-xo.html
As part of our licensing, we cannot share plan specifics on any given insurance company's advantage plans. For example, I can't say XYZ insurance company has a plan that costs this much and has these benefits.
All I can do with those is keep them general and so I use averages. In order to share plan specifics, I'd need approval from CMS - the federal governing body over Medicare. That approval takes time and likely would not allow me to share my real opinions on the plans.
Sheesh, that's never going to work out well...
Nope... no it won't... and we're not going down with that ship, haha
@@Theretirementnerds I wanted to add "You wont get away with it...Unless your a certain shade of orange President..." LOL
@@ph5915 i think politicians all around live by different rules than the rest of us, unfortunately 😕
@@Theretirementnerds Probably true...Sigh.
There is no code word, don't know what to do! :-)
Right?! Next video will have one 🙂
@@Theretirementnerds is that a kind of fraud?
@@happyron i would say it is unintentional... so more of an abuse
Why the specific windows/timing to change supplemental and Advantage plans? Seems like it’d add a lot of unnecessary administration.
All boils down to risk.
Insurance companies have to pay the costs somehow, and if people just jumped on supplement plans without every paying premiums, just when they got super sick, that puts the insurance companies in an impossible position. We are working on a video that goes over this in more detail.
@ thanks for the response. I understand an insurance co wouldn’t want to pay claims before they’ve collected many premiums, but isn’t it the same for all types of insurance?
Aww these crazy Baby Boomers. lol