On July 1, 67-year-old Annapolis resident Michele Crofoot was rushed to the emergency room due to excruciating back pain. She waited two days for surgery on a ruptured disk before her insurance company approved the surgery.

“This started at 10 a.m.,” Crofoot said. “So at 9 p.m. I’m still on the gurney in the hallway and a Kaiser ambulance finally showed up 11 hours later to take me to a different hospital where they found a Kaiser-approved doctor.”

After multiple calls between her doctor and insurance company, the surgery was performed late Tuesday afternoon, she said, not in time to prevent permanent nerve damage. Kaiser Permanente could not be immediately reached for comment. The Crofoots were on Medicare — managed by Kaiser under a two-year-old Republican plan to privatize some health care coverage.

The Medicare Advantage plans are under fire as Democrats consider cutting back the premiums that HMOs are paid. Republican congressional leaders say cutting health care premiums will make plans less flexible, increase copays, decrease benefits, quality and choice among doctors and programs. Maryland’s public Medicare recipients paid more than $12.7 million to subsidize private Medicare Advantage plans, according to an analysis released last week by Progressive Maryland. At the same time, the federal government overpaid these providers by $16 million compared with traditional Medicare programs, based on January 2007 enrollment.

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“Private insurance plans are often structured so as to discourage senior citizens to sign up for them,” said Matthew Weinstein, federal issues director for Progressive Maryland. “So [the private plans] skim off the healthier, less expensive beneficiaries, and the public sector is stuck with the sicker ones.”

Crofoot said her experience with the private plan was a nightmare.

“They took me through this beautiful building and told me all these services they offered, but they don’t offer them,” she said. “If you don’t ask the right questions you don’t get the right answers.”

A two-tiered system?

Medicare Advantage plan managers are paid 12 percent higher premiums by the federal Medicare program than public Medicare payments.

That amounts to $462 per person among the 53,486 Maryland enrollees in the Medicare Advantage program.

Source: Progressive Maryland

ekrupp@baltimoreexaminer.com