Hey Medicare Nation!
Today, I'm discussing how the Centers for Medicare & Medicaid Services (CMS) SLAPPED Agewell New York LLC with a Civil Money Penalty of $39,200!
CMS conducts audits to ensure Medicare Advantage Prescription Drug Plans are following conditions of the current contract as well as Medicare rules & regulations.
From March 9, 2018 through May 15, 2018, CMS Conducted an audit of Agewell's 2016 Medicare financial information.
In a financial audit report issued on September 20, 2018, CMS auditors reported that Agewell failed to comply with Medicare requirements related to Part C (Medicare Advantage) cost sharing.
Specifically, auditors found that in 2016 Agewell failed to comply with cost-sharing requirements by charging "incorrect" co-payments to enrollees for medical services.
Enrollees were affected in the following area:
Bronx, NY; Kings County Brooklyn, NY; Nassua County, NY, Manhattan, Queens and Westchester County, NY.
Agewell's failure was "systemic," and "adversely affected" enrollees or the substantial likelihood of adversely affecting enrollees because they experienced out-of-pocket costs.
CMS determined that Agewell was charging a $30 "specialist" co-pay was applied to "primary care physician" claims instead of a $0 co-pay as stated in the plan's Explanation of Coverage.
Enrollees were NOT Refunded the overcharged amounts until AFTER the financial audit concluded, which was 2 years after the incurred cost.
In 2016, If you paid a $30 co-pay to see YOUR Primary Physician, when you were only obligated to pay $0, you should contact Agewell at 888-586-8044 and ask to speak to a supervisor, regarding the CMS penalty. Advise the supervisor of the date & time of your appointment with your Primary Doctor and that you have proof of a payment that you made of $30 for your visit. Advise the supervisor that you would like to be refunded the $30 immediately.
Write down the name of the supervisor, the date & time you called Agewell and what the supervisor stated Agewell would do for you.
If you donot receive your refund within 14 business days, call Medicare directly at 800-633-4227 and advise Medicare of the situation.
If you have any "complaints" regarding the way you were treated by any representative at Agewell, you can make an annonymous complaint to Agewell's confidential hotline - 888-336-7240.
You can also make a complaint to Medicare directly by calling 800-633-4227.
If you have a complaint, regarding any physician or facility in the Agewell network, you can call the Agewell confidential hotline to make your complaint - 888-336-7240.
If you are uncomfortable making a formal complaint and you would like assistance with your complaint you can :
1. contact the Insurance Agent or Medicare Specialist who enrolled you into the Agewell plan
2. contact your local "SHIP" (State Health Insurance & Assistance Program) representative by "clicking" on your State here - https://www.shiptacenter.org/
when the page opens, go all the way to the bottom of the page and you'll see an "orange" button that reads -
Find Your Local SHIP
"Click" on that ORANGE buton and a list will come up of all 50 States.
"Click" on the State where you reside, to contact your local SHIP center.
If YOU need help with finding the Medicare Advantage Plan that is right for your UNIQUE needs, contact me at either:
call me at 855-855-7266
If I can answer your question in ONE paragraph in an email, I will directly answer your question!
If it takes more than one paragraph to answer your question or I need to do research to answer your question....then....I will respond by advising you that you will need to contact me and request my consultative services.
I currently charge $199.00 an hour, and I consult with Medicare beneficiaries and the Adult Children of beneficiaries ALL over the country!
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Multi Target Stool DNA Test vs. Fecal Occult Blood Test
Hey Medicare Nation!
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Let’s give YOU back some time…. So that YOU can have more time for yourself
Today…..I’m going to be talking to you about the Differences Between Multi Target Stool DNA Test vs. Fecal Occult Blood Test
Medicare offers these Preventative Tests to determine if you have blood in your stool and/or suspected cancerous characteristics.
ColoRectal cancer (CRC) is the second most frequent cause of cancer DEATH in the United States. The Most Frequent Cause of Cancer Death is…… Lung Cancer.
This year, an estimated 145,600 adults in the United States will be diagnosed with colorectal cancer.
According to Cancer.net…… an estimated 51,020 of the 145,600 adults will die this year…..due to ColoRectal Cancer.
When colorectal cancer is found early, it can often be cured. CURED Nation!
This is due to improvements in treatment and increased screening….. which finds colorectal changes before they turn cancerous and cancer at earlier stages.
Medicare Part B offers TWO Preventative Screening Tests
The First…. Is a Fecal Occult Blood Test
“Fecal Occult” Blood Test is just a scary way of saying….. “ Looking for Blood in your Poop.” The test ONLY detects the “presence” or “absence” of blood in your stool. The test does not indicate potential sources of bleeding and it does not “Diagnos” disease.
“Fecal” means……“Stool” or “Poop”….and…. “Occult Blood” means you can’t see the blood in your stool with the “naked eye,” so….. the specimen is sent to the lab for a closer look.
Blood in the stool may indicate polyps…. or it may indicate cancer in the intestine or rectum….though not all cancers or polyps bleed.
If blood is detected through the “Fecal Occult Blood Test,” additional tests may be needed to determine the source of bleeding as well as “diagnosing” an ailment or disease.
Blood in the stool could also mean Hemorrhoids….which are swollen veins in the lowest part of your rectum and anus.
Sometimes the walls of these blood vessels stretch so thin….. that the veins bulge and get irritated, especially when you poop! Straining while pooping is a major factor in Hemorrhoids. EAT more Fiber Nation! Eat More Vegetables….try Metamucil or Miralax. Straining to poop is not good. Drink more water! You should try to drink at least 96 oz. a day. I use a 24oz bottle I fill 4 x a day….. to get my 96 oz of water. You can do it. It’s important.
Hemorrhoids can cause itching & pain. Hemorrhoids can also bleed.
There are several types of Fecal Occult Blood Tests,
I’m going to discuss the “newer version,” which is called a “ Immunochemical Fecal Occult Blood Test,” (aka iFOBT or FIT)
The IFOBT or FIT test is less of a mess and easy to administer.
Typically, you have a “spoon-like” device to collect the sample of stool and you place the device into a collection container then seal it.
You either return the collection container to your doctor’s office, or you mail it.
There are no dietary restriction with the iFOB-IT and the test can be performed on any random sample of your stool.
Your Doctor will review the results and there are just two options:
This type of test ISN’T ALWAYS accurate.
Your fecal occult blood test could show a negative test result when cancer is present (false-negative result) if your cancer or polyps don't bleed.
If you had the test to screen for colon cancer and you're at average risk — you have no colon cancer risk factors other than age — your doctor may recommend waiting one year and then repeating the test.
If you have a “positive result,” You may need additional testing — such as a colonoscopy — to locate the source of the bleeding.
Under Medicare…… The Fecal Occult Blood Test…. can be given ONCE every 12 months if you’re 50 or older, at ZERO Cost to you.
Now….. let’s take a look at Mult-Target Stool DNA Tests.
You will know the “Multi-Target Stool DNA Test” more commonly known as “ColoGuard.”
ColoGuard ……. addresses several barriers to colorectal screening.
By comparison, the “Multi Target Stool DNA” screening test is a noninvasive, “multi-marker”, stool-based ColoRectal Cancer screening test…..
that detects altered De-oxyribo-nucleic Acid (DNA), , as well as a fecal immunochemical test (FIT)… for blood released from cancer and precancerous lesions of the colon.
The presence of fecal hemoglobin….. even in the absence of elevated DNA markers…..can lead to a positive result given the weighted nature of the Multi Target Stool DNA algorithm.
Patients may collect and mail stool specimens from their homes with no bowel preparations and no dietary or medication restrictions.
Medicare covers this at-home multi-target stool DNA lab test…. once every 3 years…if you meet ALL of these conditions:
ALSO YOU NEED TO BE…..
You have no personal history of … colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
If you meet the above criteria….. You pay nothing for this test if your doctor…. or other qualified health care provider accepts Medicare.
So that’s the difference between Multi Target Stool DNA Tests vs. Fecal Occult Blood Test.
If you haven’t had one of these preventative tests, speak to your primary doctor and get one. It could very well SAVE YOUR LIFE!
If you have any questions about Medicare…. Send me an email to –
I answer ALL my emails. As long as I can answer your question in a paragraph, I’ll answer your question.
If my response involves any research or it will take more than one paragraph to answer you….. I’ll send you a suggestion to hire me as your Medicare Consultant.
I charge $199.00 an hour. I’m one of the TOP Medicare Experts in the Country Nation…… I could easily command $400 or $500 an hour, but I CARE about each and every one of you! My time is extremely valuable and I want to help as many of you as I can with your Medicare problems and Medicare Plan Comparisons.
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Until next time…. I want YOU to have a Peaceful, Happy & Prosperous Week!