November 29, 2023


I really enjoyed reading this message from Wendell Potter’s Health Care Un-covered where he says:
Our reporting and advocacy is having an impact, in Washington and across the country. Members of Congress on both sides of the aisle and the Biden Administration are beginning to scrutinize and crack down on the business practices of Medicare Advantage insurers. And there is growing evidence that employers, including county and municipal governments that planned to force their retirees into Medicare Advantage plans . . . are having second thoughts. Those employers are learning that they may have been sold a bill of goods – and misled and outright lied to – by insurers that make huge profits from their Medicare Advantage business.

Potter draws heavily on a recent ProPublica report pointing out that patients are being “cheated” by Advantage plans ignoring state laws regarding life-threatening conditions.

Across the country, health insurers are flouting state laws like the one in Michigan, created to guarantee access to critical medical care, ProPublica found. Fed up with insurers saying no too often, state legislators thought they’d solved the problem by passing hundreds of laws spelling out exactly what had to be covered. But companies have continued to dodge bills for pricey treatments, even as industry profits have risen. ProPublica identified dozens of cases in which plans refused to pay for high-stakes treatments or procedures — from emergency surgeries to mammograms — even though laws require insurers to cover them.
Apparently, “thinly staffed state agencies” don’t bother investigating a denial unless a patient files a complaint. State agencies are in a position to investigate patterns of improper denials, but generally do not, at least in Michigan. Only when someone complains, I’m assuming in the form of an appeal. 

And this from a ProPublica article this past month, “Health insurers have been breaking state laws for years”:
Over the last four decades, states have enacted hundreds of laws dictating precisely what insurers must cover so that consumers aren’t driven into debt or forced to go without medicines or procedures. But health plans have violated these mandates at least dozens of times in the last five years.
Companies find ways to “weasel out” of paying for benefits that cost big bucks. If the law requires them to cover “cancer drugs,” for example, they’ll just call it something else — like, I don’t know, “gene therapy.” Poof. No need to pay.

Thirty years ago a Michigan doctor and state senator named Joe Schwarz helped write a law requiring companies to pay for cancer drugs that would make chemotherapy more effective. He thinks “You shouldn’t split hairs between the term gene therapy and the term chemotherapy or the term radiation therapy or the term surgical therapy. They’re all cancer therapies and they should all be covered.”

Most salient is the point made by one patient’s widow:  “Insurance is meant to protect people ... not to make them fight through the last day to get what they should.”

I’m with her. 

So every time groups like the one Potter runs, or ProPublica, or PNHP, or Public Citizen, or the Center for Medicare Advocacy report on the scandalous ways Advantage plans bump up their profits at our expense, I can’t help but salivate. 

I truly despise these sociopathic business models, and I hope our municipal unions stop going down such antisocial, nefarious paths.

November 8, 2023

The OLR gets an “S” – for “Sloppy”

I just tried to change my health plan and couldn’t trust any single thing in the application process.

Changing health plans is a very scary thing for older people, especially when we have no idea how the Russian roulette of life will turn out for us in the coming year.

But the OLR made the process so much worse than it needed to be. Their website was loaded with incomplete instructions, missing forms, awful ambiguities, and buggy software.

With no way to complete this application on my own, I had to call the UFT Welfare Fund to solve its mysteries. Fortunately, the rep there was great. But why on earth did I have to go through her to get this thing done. 

Here’s what I just wrote the OLR, even though I have zero expectations that they’ll fix anything or even care. After all, the site still has all the Aetna info on it (as if any of that is relevant), and if you call one of their phone numbers, the recorded message from months ago is still telling people there’s going to be so many workshops to help us understand the new – now court-stopped, defunct – plan.  

I just sent a version of this to Tom Murphy as well.  If I’ve done something wrong in this application process, I’ll own up to it, call myself a dodo bird and apologize.  But in the meantime, what I found out may be useful to others who are trying to switch plan now during the November change period.


Dear Sirs:

I am writing to describe to you the difficult process I went through yesterday trying to change from EmblemHealth HIP VIP to GHI Senior Care.

I still am not 100% sure that I have done this correctly, as so much was not explained clearly on the OLR website for Retirees:

Here is a list of things that I needed to get help with by calling the UFT Welfare Fund. All problem areas are in red ink.

1. From the above link, I clicked “Health Benefits Program Retiree Application” (
It directed me to submit forms electronically using the link: There were two categories that could apply to my situation:
  • Retirees only - Health Benefits Application (Retiree enrollment)
  • Changes (address changes, death certificate, Medicare cards, etc.)
You can see the problem: I am a retiree and want to enroll in a different plan. Should I click the first link (Retirees - Health)? or the 2nd link (Changes)? I don’t remember which I one I did, but they both seem to lead to the same cover screen. I wrote a message and selected files to send individually.
2. Back to the Retiree page to get the forms. I clicked on “Health Benefits Program Retiree Application” but the DATE OF BIRTH cell did not accept my date of birth because of a bug. So I could not fill it out electronically. Instead I had to print it out, fill it in by hand, and scan it to the computer to submit electronically.

3. I did not know how to fill in some of the other boxes and had to call the UFT Welfare Fund to ask for help on these things:
(a) That change form asks for “Pension no.”  I checked my TRS account, and the only nos. listed there are called a “Retirement no.” [starts with “U”] and a “Membership no.” The UFT rep told me to use “the one with the U”. Who knew!@?
(b) After the box for name of current health plan is a box for “MBI NUMBER”. I had no idea what that was – my Medicare ID? my plan enrollment no.? The UFT rep said “Don’t worry about it,” as it wasn’t needed.
4. The UFT rep told me I actually had to upload TWO forms – the change form above, plus a disenrollment form for my current plan. That was not mentioned on the website, and I could not locate a link for that 2nd form either. She had to send it to me by email.
c) That form asks for an “effective date,” but I wasn’t sure which date should be there. Does it mean to enter the last date that my current plan should run to (end of year: Dec. 31, 2023) or end “by” the first date of the new year (Jan. 4, 2024). It would be clear if the wording were more specific, like: “Final date of current plan.”
5. I asked the UFT rep whether it was better to send electronically or by mail. She said “do both.”

6. When I submitted electronically, the software said “Success,” but how do we trust that message where there is no date or other details of the submission. I would have liked to take a screenshot (if details were there) or receive an email from the software that my documents were received.

7. I am now supposed to wait 4 - 6 weeks to see if this goes through??????  That’s insane.

Please can you tell me if you have received my application for change of health plan and that everything is in order.