Retired NYC employees sue to block new ‘inferior’ Medicare coverage

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​ ​ RETIRED LIEUTENANTS ASSOCIATION NYPD ​ Mayor, keep the city’s promises to its retirees​ ​ the Chief, Tuesday, July 9, 2024 BY MATT WEBER Once again, Mayor Eric Adams has chosen to overlook critical facts and components of the Retirees’ Medicare Advantage program he so strongly endorses. Material misrepresentations must not be forgotten or ignored. Retirees were told repeatedly that under the mayor’s plan, they would continue to experience unhindered access to treatment and care from any doctor or facility that accepts traditional Medicare, and they could do so without experiencing astronomical out-of-pocket costs. Clearly the mayor and his advisors were either misinformed or lack critical insights that would enable them to distinguish traditional Medicare Parts A and B from an inferior privatized, for-profit Medicare Advantage plan. Facts matter. For instance, • NYC municipal retirees earned and were promised traditional Medicare coupled with premium free supplemental coverage. • Predicated upon promises made to them, NYC retirees have chosen to live throughout the United States. • Through rigorous standards, the National Cancer Institute identifies Centers of Excellence for cancer screening, treatment and care. These centers are located throughout the United States. • Most, if not all, NCI Centers of Excellence participate in traditional Medicare Parts A and B. • Numerous NCI Centers of Excellence do not Participate in Medicare Advantage Plans. Representation made by the mayor’s delegates in regards unhindered access to treatment and care were at best, uninformed. • If Adams is successful in forcing NYC’s municipal retirees into his Medicare Advantage program, people who sacrificed unselfishly will be irreparably harmed. • An objective and thorough assessment of efficiencies and cost-savings that could be achieved by combining the greater than 100 independent union welfare funds has not been accomplished. • If the Municipal Labor Committee, the umbrella organization of city public-sector unions, combined most, if not all, of their welfare funds into one organization, enormous recurring administrative, operating and capital cost savings would occur. To date, the mayor has chosen to ignore this opportunity; instead, he chooses to implement a plan that hurts the most vulnerable among us; the elderly, infirm and disabled. Shame on Mayor Adams. It is time for the mayor to convene a retiree health care panel to educate and guide him; a panel comprised of objective, knowledgeable, analytical, critical thinking subject matter experts. The president of the New York City Organization for Public Service Retirees, Marianne Pizzitola, and the United Federation of Teachers’ Retired Teachers Chapter’s leader, Bennett Fischer, should be designated as the panel’s co-chairs. My mother, Judith A. Weber, who taught at PS 241 in Crown Heights for 26 years, was a mentor for many. She also was a proud supporter of Albert Shanker, the UFT’s president for two decades, a world-class union leader and a strong believer in the premise that a solid education best positions people for success. Mom was adamant that she and her colleagues were unequivocally promised traditional Medicare coupled with premium free supplemental insurance throughout retirement, period. Up until a few days before passing at the age of 97, Mom encouraged me to champion on behalf of all city retirees and especially individuals like her: frail, elderly, infirm individuals who literally did not have the strength to fight for themselves. I honor my mother by joining tens of thousands of others who know that facts matter, and understand that promises made, are promises to be kept. Matt Weber is a retired manager with NYC Health and Hospitals Corp. and a member of the NYC Managerial Employees Association. ​ ​ ​ ​ ​

Retired Lieutenants Association NYPD | 266-19 Hillside Avenue | Floral Park, NY 11004 US​

 

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Medicare Advantage Bad News​

Uncovered - 8.19.24 - UPDATEDOver the past few days, both CVS/Aetna and Humana admitted to Wall Street that their Medicare Advantage plans are not nearly as profitable as those insurers had predicted a year ago. As a consequence, hundreds of thousands – and probably millions – of seniors and disabled people enrolled in Aetna’s and Humana’s plans may soon wish they had never heard of Medicare Advantage.
Aetna president Brian Kane probably wishes he had never heard of Medicare Advantage, either. The poor guy got canned in a very public way yesterday, presumably for overseeing the payment of too many Medicare Advantage claims during his short tenure at Aetna. His boss, CVS CEO Karen Lynch, said during the company’s second-quarter earnings call with investors and Wall Street financial analysts that Kane, who joined the company just last September, was leaving Aetna “immediately.”
As sorry as I am for Kane, I am much more concerned about the health and well-being of the 4.3 million people enrolled in CVS’s MA plans and the 6.2 million in Humana’s plans. Sadly, most will find they’re trapped in a circle of hell created by the insurance industry, unable to stay in their current Medicare Advantage plan but also unable to return to traditional Medicare because of what for them will be unaffordable Medicare supplemental policies (most of which are sold by the same big insurers that sell MA plans). Seniors have six months from the date they’re eligible for Medicare to buy a supplemental (Medigap) policy to cover out-of-pocket expenses. If they’ve been enrolled in an MA plan longer than six months, they’ll have to go through medical underwriting. That means that if they’re being treated for much of anything or, God forbid, have a “preexisting condition,” they’ll have to pay an arm and a leg for Medigap policy.
Humana said last week it planned to jettison “a few hundred thousand” of its Medicare Advantage enrollees that have become unprofitable. CVS says it will get rid of about 10% of its MA enrollment, which would be around 430,000 of America’s seniors and disabled people. Most of those folks likely will be able to enroll in another insurer’s MA plan (although the options will be more limited in many counties), but they likely will find that their premiums will be higher, their benefits skimpier, and that some of their preferred doctors and hospitals are not “in-network.” As HEALTH CARE un-covered has reported, a growing number of physician practices and hospitals are now refusing to take Medicare Advantage patients.
It’s important to point out that Humana and CVS/Aetna are still making very nice profits, even on their MA businesses, but Wall Street doesn’t like any part of a company to be less profitable than they had been told to expect. So, when investors send a message – by dumping their shares – the C-Suite listens. Executives swing into action to try to staunch the bleeding, especially considering that most of their compensation is paid in stock.
Both Humana and CVS have been in the Wall Street doghouse for months now because of their lackluster MA operations. Humana’s shares have lost an astonishing 33% of their value since last October. CVS/Aetna’s shares are down more than 32% since just the first of this year. I handled financial communications for Cigna for 10 years and I can’t recall such a long stretch of decline. But when Cigna shares did take a big hit after a disappointing quarterly earnings report, it would be all hands-on deck to turn the ship around.
At Humana and CVS/Aetna, some of the hands will be hard at work identifying unprofitable enrollees to dump. Other hands will turn to “utilization management” (a.k.a. medical cost management). That means the companies likely will ratchet up prior authorization requirements, refuse to pay claims they previously would have paid (making greater use of AI in both endeavors), and make enrollees pay more in premiums and out-of-pocket requirements.
Both companies are finding out that the big bets they placed on MA in years past are not paying off. Expecting an ongoing gravy train from the government, Aetna spent heavily on MA marketing last year and saw its enrollment increase by 33% between December 31, 2022, and June 30, 2024, from 3.3 million to 4.3 million. Aetna will be trying to run off many of those 1 million new enrollees before the end of this year.
Humana also bet big and, it seems with hindsight, recklessly on MA. On February 23 of last year, it announced it was getting out of the employer-sponsored health insurance business entirely so it could focus exclusively on Medicare Advantage and other taxpayer-funded programs. Wall Street didn’t balk at that decision initially, but I suspect many investors and financial analysts are now questioning the sanity of the company’s leadership.
Company executives have tried to reassure investors they have a handle on all the levers at their disposal to get their profit margins back to levels deemed satisfactory to Wall Street. They do the reassuring in language that most of us couldn’t make heads or tails of, like this from Humana CFO Susan Diamond during the company’s second-quarter earnings call on July 31:

On the inpatient (hospital admissions)…we do within our utilization management programs, have what we call a frontend review process. So we are reviewing those authorizations in real-time as they come in for things like medical necessity and site of service effectively…There is also activity that we do after the claim comes in, which we call a postpay review, where there are some incremental opportunities to just review, again the more specificity on that claim to make sure it's appropriate and we get value from both sides of that.

What this means is that doctors will find more of their decisions being second-guessed by Humana beancounters, they’ll encounter more questions about the necessity of a proposed treatment, medication or hospital admission, and they’ll see more of the claims they file being paid only in part if at all. If all that makes doctors’ lives more miserable, if it means some patients won’t get medically necessary care, so be it. In Medicare Advantage, Wall Street will not be happy until profit margins start growing again, and nothing – nothing – is more important to the CEOs and CFOs of these publicly traded companies than Wall Street’s happiness.

PS: Yet another big Medicare Advantage player, Centene, says it, too, will be cutting thousands of its enrollees adrift as it exits counties in six states. Nearly 40,000 seniors and disabled people will be affected.

 

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RETIRED LIEUTENANTS ASSOCIATION NYPD

Letter from Office of Labor Relation, Renee Campion, Commissioner.

September 17, 2024

Dear City of New York employee,

You may have recently received a letter from Memorial Sloan Kettering (MSK) regarding their negotiations with the City’s insurer for hospital benefits, Anthem Blue Cross and Blue Shield (Anthem). It was disturbing to the City and the Municipal Labor Committee that MSK chose to involve patients in their negotiations with an insurer, and we are writing to clear up some of the misinformation and confusion caused by the letter.

Anthem is negotiating with MSK to continue their agreement for 2025 and beyond. Provider contract renewals are a routine and normal part of the health care industry, and typically, these negotiations settle close to the renewal date. The City is optimistic that Anthem and MSK will reach a new agreement before the current contract ends on January 1, 2025. However, you should be aware that MSK failed to mention in their letter that New York law requires both Anthem and MSK to honor the terms of their contract until at least March 1, 2025. Additionally, in the unlikely event that MSK exits Anthem’s network, there is an agreement that ensures that all patients who begin treatment before March 1, 2025, will maintain their benefit coverage at MSK for the entire duration of their treatment.

You should also be aware that these negotiations do not apply to retirees in the Senior Care plan since Medicare is the primary payor.

If you are undergoing treatment at MSK please continue as you have in the past. Anthem has set up a website at Anthem.com/MSKCONY with information on the negotiations. That site will be updated as negotiations continue. You can also contact Anthem Member Services at the number on your ID Card.

Be assured that we are monitoring the situation closely and will keep you informed.

Sincerely,
Renee Campion

OLR Statement Regarding Memorial Sloan Kettering - NYC MEA NYC Managerial Employees Association: The ONLY Advocates for Managers.



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Retired Lieutenants Association NYPD | 266-19 Hillside Avenue | Floral Park, NY 11004 US

 

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​ ​ RETIRED LIEUTENANTS' ASSOCIATION NYPD ------------------------------------------------------------------------------------------- We are forwarding this email regarding the NYC Organization of Public Service Retirees lawsuits, their cancelled Rally on October 10, 2024, and their updated donation information as requested by several members -------------------------------------------------------------------------​ THE OCTOBER 10th RALLY IS CANCELLED! WE WILL RESCHEDULE MOST LIKELY FOR OCTOBER 23rd. I WILL EXPLAIN MORE AS WE GET CLOSER. I AM SORRY AS I KNOW YOU ALL WERE LOOKING FORWARD TO THIS! WE TRIED UP UNTIL LATE TO MAKE THIS WORK. TRUST ME..... IT WAS NOT US.. BUT THERE IS ONE PERSON.... AND WE WILL SHARE THAT SOON TOO.... I JUST CAN'T "SPEAK" ABOUT IT NOW!!! THE LATEST QUESTION ON THE BROWARD 10-13 MEETING ON THE AETNA PLAN. WHEN SABRINA DOESN'T ANSWER THE QUESTION, WE DO! FLORIDA Aetna Retirees will LOSE THEIR PLAN if the City Wins (youtube.com) Marianne Donations are Needed!​ TO DONATE TO THE ORGANIZATION​ ​ Donation Instructions to Support Our Organization and our Fight To Protect Our Retiree Healthcare:​ ​ We worked decades for our benefits! Let’s make sure the City and the MLC don’t take them away!​ ​ A suggested $25 Donation* will help start the fight to keep our current benefits.​ ​ *Give more if you can, and/or often! If you cannot meet the minimum suggested donation, we appreciate whatever you can give towards this fight for our benefits. We also added the option to make your donation recurring (monthly) as was requested.​ ​ We are incorporated as a 501c5, Non-Profit, but not tax deductible. ALL proceeds go to fund the organization and its legal challenge. Volunteer retirees are running this effort.​ ​ TO DONATE, HERE ARE 4 SIMPLE WAYS!​ ​ 1.Zelle using email NYCOrgofpublicserviceretirees@gmail.com YOU CANNOT USE THE ZELLE APP! You must use Zelle via your online banking. In some cases you cannot use the Zelle via the bank app either. So if you're finding trouble, use the computer and make the payment via Zelle from your online banking.​ ​ 2. Make your check out to:​ NYC Organization of Public Service Retirees​ c/o JSH Accounting Services LLC​ PO Box 143538​ Fayetteville, GA 30214​ (this is the organization's accounting professional DO NOT MAKE THE CHECK OUT TO THEM!)​ ​ 3. Or click on this Paypal link:​ https://www.paypal.com/donate/?hosted_button_id=Q4VWJEYVJ9HTW&Z3&fbclid=IwAR0pEOc51x9xhc-CBb8vqAIkX97Bgg1Z02f1r9gQh9S3dOsVmAdob5jBbw8​ ​ 4. VENMO OUR Venmo Name changed! Please take note! VENMO is a Phone App or can be used on a PC or Tablet You can download and install the Phone App from the Android Play Store or Apple App Store. There may be fees involved using this method. Our NEW ID is: @NYCRetirees2 If you are on this list, it is because you subscribed to hear what we are doing as an organization that represents all NYC Municipal workers in protecting their Health benefits in retirement. Currently, we have a FACEBOOK page located here: https://www.facebook.com/groups/888622578669131 If you are not on FACEBOOK, we will be updating you here. And Check our website for FAQ www.nycretirees.orgThank you for signing up for our newsletter and pass this to a friend to sign up too!​ ​ ​ ​ ​ ​

Retired Lieutenants Association NYPD | 266-19 Hillside Avenue | Floral Park, NY 11004 US​