Dr. Izzy’s Sound News

Medicare Advantage Plans May Be A Disadvantage!

The carnival barking celebrities are relentless on television. They attempt to persuade you to call to check your zip code with a promise of getting money put back into your monthly social security check when you sign up for the XYZ Medicare Advantage Plan.

Extra benefits are touted over and above regular Medicare at no cost to you. The problem is the taxpayer price tag is enormous and quality of benefits is putrid.

A couple decades ago, Federal legislation was passed to improve quality of health care and lower the cost through Medicare Advantage plans. Insurance companies are required to report financial data to State regulators. Today, it is estimated close to fifty percent of Medicare eligible policyholders have signed up for a Medicare Advantage (MA) plan.

An investigative article was published in the October 22nd, 2022 The New York Times. It was reported that nine out of ten MA providers were found to have committed and been accused of fraud. These private sector MA alternatives were supposed to be better than regular Medicare. They are not.

The MA companies inflated profits and received more money from the Federal government by reporting many patients more sick (increased number of diagnosis codes) with these over-diagnoses garnering higher payments. The Federal government spends as much on MA payouts as in funding the Army and Navy. The $12-25 billion in overpayments are enough to cover hearing and vision for all individuals over the age of 65.

Federal expenditures for MA total more than budgeted for NASA, CHIP (children’s insurance), U.S. Customs & Border Protection, FBI, EPA, and the Federal prison system.

MA limits choice of physicians, specialists, and hospitals within a smaller network for coverage and payment. Additionally, policyholders must jump through hoops to acquire required care for their anomaly. Annual profit per enrollee for MA insurer is close to $2300. The MA program looks to pay out less money, restrict access to care, and gives providers a lower reimbursement.

For hearing aid benefits, an MA plan utilizes a third-party administrator. This company lowers the rate of reimbursement to audiologists to the bare minimum. This administrative company receives money from the Federal government through your

Medicare payment and your co- pay of $700 to $1000 per device, issues the hearing aids to the audiologist for your fitting, and 60-90 days later mails a service reimbursement of about 14% from the entire amount they collected. My own investigative inquiries with MA plans and administrative contractors, the actual dollar amount they pay is LESS THAN what is paid by medical assistance (MEDICAID) for the same service given to the indigent.

The MA model of providing hearing aids to policyholders encourages audiologists to get that handicapped patient in and out of their office quickly and sacrifices required care, counseling, aural rehabilitation, and computerized adjustments for patient success. “Best practices” are thrown out the door because dispensing audiologists cannot afford to spend the same amount of time for the 3rd party patient. The MA plan doesn’t typically have all manufacturers available and limits choice of product to be considered in patient fitting. Often it is a basic level hearing aid fitted with minimal care. From a business perspective, it is a churn and burn model emphasizing quantity versus quality. Hearing handicapped patients are sacrificed. Dispensing audiologists are forced to severely reduce service and time to patients.

In the MA model, policyholders are forced to lower their expectations because this is a race to the bottom mentality where the patient is neglected in product and continuity of continuing service.

Out of the delayed and low reimbursement (below the medical assistance fee schedule), to dispensing audiologists, they must pay taxes, rent, utilities, office costs, and attempt to make a profit to cover a salary. The patient may have 1-3 visits included during the first year of service. After this time period is up, the provider is permitted to charge $60 to $125 to $225 for every single office appointment lasting about fifteen minutes. The MA policyholder/patient may think they are getting a deal in hearing benefits. However, they will pay even more in the long run or avoid seeking the required hearing care due to the future cost. Your Medicare ADVANTAGE plan may ultimately place you at a DISADVANTAGE.

Dr. Izzy and his Staff are always available to provide you with informative information about your hearing care needs. Please visit us at www.gardenstatehearing.com or call 732-818-3610 (Toms River/Whiting) or 609-978-8946 (Manahawkin).

Suzy Cohen, R. Ph.

Parathyroid Disease: An Insight Into My Journey

By Suzy Cohen, R. Ph.

In the fall of 2022, I underwent surgery for hyperparathyroidism, a condition impacting the parathyroid glands responsible for regulating calcium levels in the body. I’m telling you all today because my story might help you too! The number one symptom of parathyroid problems is chronic fatigue. And here I thought I was just overworking myself!

The parathyroid and thyroid glands, despite their similar names, are distinct. While the thyroid gland primarily regulates thyroid hormones, the parathyroid glands control calcium and phosphorous levels, crucial for our muscular and nervous systems. Having a parathyroid condition does not have anything to do with thyroid disease. Again, the 4 parathyroid glands regulate minerals, the same ones that keep your bones strong, and your teeth healthy. The same minerals that conduct heart rhythm and muscle contraction.

I had secondary hyperparathyroidism, and to cure myself, I had to have a quick surgery to remove the benign tumors on the glands. It sounds scary, but it’s a pretty straightforward surgery. I was able to tape videos right afterward to show you. The video is posted on my website.

Hyperparathyroidism results from a benign tumor in one or more parathyroid glands, leading to excessive PTH (Parathyroid Hormone) production and often causing hypercalcemia or high calcium levels in the blood. Contrary to common belief, hypercalcemia doesn’t strengthen bones. In fact, it weakens them by causing calcium dumping from the bones into the bloodstream.

Thyroid and parathyroid diseases, though closely located, impact the body differently. While thyroid hormones require iodine and other cofactors, PTH demands four healthy functional glands. Also, having one disease doesn’t automatically make you susceptible to the other.

Though parathyroid disease isn’t cancer, it does slightly increase cancer risks. The exact cause of this condition, specifically why a parathyroid cell forms a tumor, remains largely unknown. However, genetic predisposition is commonly observed.

Hyperparathyroidism affects 1 in 80 people, with a higher incidence in women above 50 years of age. Sadly, about 70 percent of patients remain unaware of their condition due to inadequate attention to detected high calcium levels. Most symptoms of hyperparathyroidism, like fatigue, insomnia, kidney stones, and bone pain, are tied to hypercalcemia. The severity of symptoms depends more on the duration of elevated calcium levels rather than the extent of elevation.

Surgical removal of the benign tumor is the standard treatment for hyperparathyroidism, restoring calcium balance and alleviating symptoms. This condition has a significant effect on a person’s life expectancy and overall health. Because I feel so much better now, I can’t emphasize to you the importance of prompt treatment if you have elevated PTH levels. Despite the challenges, and there were some, I think the surgery and recovery can immediately restore your health and vitality, as well as faster weight loss and stronger bones. If you’d like to read my complete article, or watch my video, visit suzycohen.com and while you’re there, please sign up for my newsletter so we can stay in touch by email.

©2022 SUZY COHEN, RPH. DISTRIBUTED BY DEAR PHARMACIST, INC.