The MLC Medicare Advantage Plan

Lisa R. Parker

Bear with me for a few paragraphs, please. The other day I got a bill from Quest Diagnostics for $151.00. Evidently, it was a 20 dollar co-pay for one test, originally over 200, but after GHI sent them 8 bucks, I had only the co-pay. The other was the full, non-discounted amount. I was not happy.

I called Quest, got a message they were very busy, but if I pressed 1, they would call me back in twelve minutes. They did not. I called again, waited for twenty minutes, and got someone on the phone. This person insisted I call the insurance company, which hadn’t paid. I called GHI and got a response immediately. The woman told me there were two conflicting codes, and that one had to be eliminated before they would pay.

I called Quest, waited another twenty minutes, and was explaining the situation to someone when we were disconnected. I called again, waited another twenty minutes, and the woman told me that only the prescribing doctor could change the codes. I didn’t recognize the doctor’s name, but she eventually identified the doctor’s office, which I recognized. After losing an hour and a half over this nonsense, I called that office and left a message. 

Why am I telling this long, drawn-out story? I’m telling it because I am beginning to expect this very sort of nonsense from the Medicare Advantage plan MLC wants us to use. Its history is short, but utter chaos.

GHI has been pretty good to me, and their service is and has been better than other companies, like Quest for example. I was prepared to try the Medicare Advantage program endorsed by the city unions. However, Emblem/ GHI is no longer going to be the provider. It appears if Mayor Swagger and various unions change the law, the provider will be Aetna. I know nothing about Aetna, and I’m not prepared to trust my health to them.

This means when I (and eventually my wife) go to Medicare it will cost us $4584 a year out of pocket to get the medical plan city retirees have been getting gratis forever. And by gratis, I mean after having devoted twenty, thirty or more years to the city. I can swing it, I suppose. (Of course I’m not a DC37 worker trying to get by on minimum wage or thereabouts.) Still, I’m not getting what I was led to expect for the 38 years I’ve given this system.

Once we open the door to premiums, which we are doing here, we know well where it can lead. It leads to a friend of mine facing 12K a year, now, to keep health care if he retires. Of course that can increase, and it’s done so disastrously and spectacularly, leading to red state rebellions. In fact, by changing the law, as Adams and various unions are trying to do, it means that standard Medicare prices can go up by pretty much any amount. Are we going to rely on Mayor Swagger to contain costs? (How is that a photo op for him?)

The Advantage plan sounded acceptable to me when GHI was going to run it. Of course, I live in the area, and I’m well-served by this plan. If I lived anywhere but here or Florida, that would be an issue. I have a friend in PA who’s very concerned about this, and will surely have a $4584 annual expense if this goes through.

It’s great that this plan pays doctors the same as standard Medicare. It’s problematic, though, that MLC didn’t bother to recruit doctors to participate. It’s further problematic that this payment agreement can change at any time. In a further cost-saving method, the MLC could cut doctor payments, and effectively cut available doctors (assuming they actually bother to recruit any, which they thus far have not). Unlike many, I don’t believe this is a Joe Namath Advantage scam. But it could easily degenerate into one. 

Unity is not thinking ahead. This plan is exactly why they won this year by the lowest percentage ever, and exactly why they could lose the next election. Having dealt extensively with the major opposition party, I don’t trust them as far as I can throw them. It’s beyond disappointing that this is all we can muster in such a potentially vibrant and effective union. We, the UFT, are poorly informed and not remotely as active as we could be.

In any case, the entire Medicare Advantage plan was abysmally planned. It lacked vision, and MLC didn’t bother at all to prepare for the totally predictable outcry that ensued. Some leaders have their heads planted firmly in the sand, and are still insisting that everything is perfectly fine. However, this is a disaster, no matter how much makeup they paint over it. 

We deserve better.

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