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On November 5th, Healthpartners (HP) and United Healthcare (UHC) announced they have resolved the 2025 contract issues for Medicare Advantage Plan participation. On November 9th, City Benefits announced agreement had also been reached with Essentia for 2025 UHC coverage.
HP issued a letter which will be USPS mailed to all HP Medicare Advantage Plan patients, stating they had reached an agreement with UHC that addressed its concerns of the medical claims processes. The letter goes on to say that HP is sorry this situation has caused uncertainty and stress for many of its patients over the past few months.
Police Federation President Mark Ross and Fire Local 21 Union President Mike Smith both wrote letters to the Mayor, HP and UHC in the late stages of negotiations, urging action.
City Benefits and UHC have confirmed the resolution of the impasse. To be clear, the HP letter indicates this HP agreement with our UHC Medicare Advantage Plan is for the 2025 contract year only.
Early Retirees (under 65y) are receiving open enrollment forms in the USPS mail now. Regular or Medicare Retirees should be receiving open enrollment forms soon. Open enrollment is November 11th through November 22nd.
Some time ago, we notified the Federation that Regular Retirees were not allowed access to unused health insurance benefits to pay Medicare Part B premiums. The first Federation attorney had a strange response and rejected our position (see newsletter accounts here).
Federation President Mark Ross disagreed with the attorney's opinion and decided to pursue the issue directly with City Labor Relations. In August of this year, President Ross requested a documented interpretation why the City is choosing to withhold our use of excess Federation benefits for a City-provided health insurance premium.
The City replied to the Federation soon after.
We at the SPPRA find the City response incomplete and inaccurate. The Part B premium is not separate nor is it a part of a third-party insurance program. The Part B premium is a seamless requirement of the only private health insurance plan offered to Regular Retirees under contract.
Hopefully, those of you on and approaching Medicare have been following the insurance coverage news here and in the media.
We and the St. Paul Veteran Firefighters Association (retired firefighters) discovered our City Medicare insurance contract expired at the end of this year. When we investigated, we found there had been no mention of it at the St. Paul Labor Management Committee on Health Insurance (LMCHI).
Management routinely discusses and negotiates with Labor all health insurance provided by contract or CBA. Or so we foolishly thought. The LMCHI is composed of representatives of all bargaining units in the City (unions) and City Benefits team members.
We requested our representatives from the Federation (Police) and Local 21 (Fire) place a letter on the August 12 meeting of the LMCHI agenda asking what is in store for 2025 City Medicare users. Go here if you'd like to read about what we found out.
Early in July, Don Grundhauser was diagnosed with colorectal cancer with metastasis to his lungs, liver, and lymph nodes.
So, we need to show up big for Donny
The funds raised for the family here will help give access to so many big needs and the best treatment possible. Specifically, it will support traveling across the nation for special treatment. Together we can help with this and many other expenses like gas, parking, meals, medical, and others that we cannot even anticipate.
Thank you in advance for your generosity and support for Donny and his family. Please use the button below to help out.
"...Blumenthal joined state (Connecticut) disability advocates in criticizing the deceptive and misleading advertising of in-state insurance providers, particularly UnitedHealthcare, which made false or misleading claims in promotion of Medicare Advantage. Blumenthal said that the blame for Medicare Advantage’s inadequacy falls at the feet of private insurance providers. “Quite simply, the insurance companies are profiteering,” said Blumenthal. “They are taking advantage of excuses to deny or delay coverage, and the victims of those practices are patients and their families..."
"...Furthermore, Connecticut State Senator Saud Anwar said that, in 2022 alone, 3.4 million prior authorizations for care had been denied by Medicare Advantage. That number represented 7.4% of all service and care requests made by Medicare Advantage policyholders. Anwar noted that 83% of appeals were successful, ascertaining that this statistic showed how many of those denials were wrong. “This is the cause of a significant burden in the healthcare system, to have people fight on the phones in this archaic manner, to wait and listen to music for hours, to be able to get their medications” said Anwar..."
Read news articles about the report here and here. The full Senate Subcommittee report is here.
"...An estimated $7.5 billion in risk-adjusted payments was pocketed by MA insurers (Medicare Advantage Plan insurers) when diagnoses were only found on chart reviews but no other service records. At-home visits and chart reviews make up $4.2 billion of the total payments from the government to MA insurers in fiscal year 2023, yet at-home visits make up just 13% of all chart reviews..."
"...There were no follow-up visits, procedures or tests provided to 1.7 million enrollees, leading the feds to believe the diagnoses were incorrect or members were not adequately treated. Private insurers received greater payments from at-home reviews than other types of chart reviews. MA companies generated $1,869 on average in payments from at-home visits, versus just $365 from facility-based chart reviews..."
"...Of the $7.5 billion in risk-adjusted payments, 20 companies received 80% (or $6 billion) of the funds yet only treat half of MA enrollees. These companies received a share of payments that exceeded their percentage of enrollees by more than 25%, the report explained. UnitedHealth Group earned $3.73 billion in payments, by far the most of any other health plan..."
Read news article about the report here.
Social hour starts at 4:00 pm with dinner orders taken around 5:00-5:15 pm. Cost is $35 which includes choice of entree, two drinks, dessert and tip. Please notify Dan Collins by noon on Tuesday, November 12th if you plan on attending. Arrive by 4pm for the best seating options.
The mission of the association is to foster relationships of SPPD retirees and their spouses, provide comfort and support for members and their families that have fallen ill or passed. In addition to monitor legislative and health benefit issues and be a voice for related concerns.
Our membership is open to all honorably retired St Paul Police Officers. Survivors of our fallen brothers and sisters are also welcome to join. We offer a range of benefits and services to our members including networking opportunities, support advocacy and access to specific PERA and Health Benefit resources.
We strive to stay in touch with our members. If you have a question or concerns about a fellow member or the organization please send us a message. We are always happy to hear from you.
SPPRA P.O. Box 7398 St Paul, MN 55107-0398
Copyright © 2024 St Paul Police Retirement Association - All Rights Reserved.
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