Medicare Advantage: When an insurance company to make house calls

When I was a kid, my doctor visits are always made when we were too sick to come to his office. But he stopped to visit people at home before retiring. 

He and his patients realized they were perhaps better served by going to your own office, well equipped for the care they needed.

So I am more than a little surprised when a woman representing my health insurance plan have called to book a home visit, a nurse or doctor. I have a Medicare Advantage plan, and thought it offered me this visit, because the appellant assumed he was frail and leave. 

I assured him that he could easily reach my doctor's office if necessary. I also just had my annual physical, my vaccines and tests were under way, and I felt great. Why do I need a call from home?

The only reason I can give is that the doctor would have more time with me than my doctor did. The house tour was to last 45 minutes to an hour and include a medical history, physical examination and health advice. Since I work full time, you can program the visit of a weekend. And she even threw in a gift card for $ 25 Walmart if I finished the exam. 

I refused, feeling a little creeped out - especially after consultation with my doctor and learn that she knew nothing of this. So I did a little research. 

I learned that these visits are legitimate - indeed, more than one million patients are registered for them so far. And I learned that a further examination has reduced hospitalizations, especially for patients with diabetes, heart failure or chronic obstructive pulmonary disease.

But what always puzzled me was why my insurance company want to hire the extra expense of doubling the examination and tests my doctor came. I do not have serious medical conditions and my regularly receives top marks from all classification systems.

A method for the alleged insanity

Dr. Michael McWilliams suggested an answer. As a partner of the health care policy at Harvard Medical School, which includes the arcane rules covering how Medicare reimburses my Medicare Advantage plan for care teacher. 

He said that each of us covered by these plans is assigned a risk score. As we develop more health problems, increases our risk score. "Home visits by Medicare Advantage plans allow the capture of more diagnoses, which in turn increases the risk score that adjusts Medicare payments. In general, recorded diagnoses, plus the payment," says Dr. Williams.

He explained that the risk equalization system was created to ensure that the plans are not only enroll healthy patients who are less likely to have to pay for expensive procedures and hospital stays. To provide an incentive for insurers to cover the sickest patients, the plans pay proportionally more for their care.

I received two calls from that rejected the home visit, each more persistent than the last. Now I understand why. If your doctor can diagnose me with a serious health problem, the company could increase my credit score and get a higher Medicare reimbursement each time you visit the doctor.

What to consider if he is offered a home visit

If you or someone you know has offered a home visit from a Medicare Advantage plan, consider the following:

       *  If you have a serious health problem, special attention can help prevent hospitalization.
       *  The care they provide is not permanent. This is the only time you see the doctor who examined. The test results and evidence will be sent to your doctor regularly for follow up.
 
       *  If you're healthy and stay results in an increase in the risk score, you will not have to pay more for their care. But the higher Medicare reimbursement received your insurance may contribute to rising costs of the nation's health care.
 
       *  You are not required to have a tour of the house - they are completely optional. 
By: Beverly Merz