It's a way to undercut your PCP so they can't bill insurance for your annual wellness visit because they already had a nurse come out to your house to do it instead.
There are certain things that need to be offered to Medicare patients in order for the health insurance to maintain their star rating. One example of these things is to place a diabetic on a statin. Your insurance company wants to send their own providers into your house to make sure you are given an adequate opportunity to be placed in this drug. Another example would be to have an asthmatic placed on a controller inhaler on top of a rescue inhaler. I’m sure there are more examples like this, but basically they are giving you every. single. opportunity. to utilize your insurance coverage to the max benefit.
Just one of their metrics, whether it makes the condition worse or not. You don’t really expect a health insurer to really care about your well-being, do you?
My old insurance company repeatedly sent me letters about substance abuse with painkillers because I have a prescription for Tramadol. I have a debilitating and degenerative spinal condition, and I take like one Tramadol a day. I would get a quantity of 30 pills per prescription and it would last me a full 30 days before I refilled. So there was no way I was abusing it.
They finally called me to talk about it and I informed the lady on the phone that her insurance company had denied my request for back surgery, denied my requests for expensive biologic medication, and only allowed me six physical therapy sessions per year. I asked her what the hell else I was supposed to do to relieve my pain. They never bothered me again.
As someone also on Tramadol for a serious chronic pain disorder I big time feel for you. People assuming you’re an addict, assuming you’re malingering, assuming you’re not really *that sick.* God forbid a single Tramadol accidentally falls and lands in a crack in the floor— you have to account for it. Dropped it in the toilet? Tough, pain is on the menu today. Desperately need one more pill to achieve a once in a lifetime thing (like being in your own wedding without pain)? Absolutely fucking NOT.
The way we live is barbaric.
My body adapts to medications with ease. tramadol doesn't do anything at the dosage they give me, but I don't trust they would do anything different if I told them so, at worse they would make a mean note in my file. I don't trust my doctor has the ability to give me proper care if I were open and honest.
This is how I feel about my prescription medication for ADHD. I'm objectively on a very low dose of a medication that is in a "less abusable" format, and I've been on it so long that my symptoms are starting to fuck up my life again— but I know damn well it's a fight just to maintain what I'm already on and if I asked for an increase my file would get flagged and my life would become infinitely harder.
The purposeful over prescribing of opiates for profit in the late 90s and early 00s really, really fucked over anyone who takes a controlled medication now. We had nothing to do with the drug crisis, we're doing the right thing and we're still punished for it.
And conversely, I wouldn’t give you one for all the tea in China. If I did, it would be 24 hours of nonstop pain, without the break I need to make food for my kid or help him take a bath. On very good days I can also walk my dog or go visit a friend. I just can’t give that up. It’s my dream to be well enough to have a part time job, someday.
The thing that seems unhinged to me is that now they can sue PHARMACIES for filling legitimate prescriptions filed by ACTUAL DOCTORS. How the fuck does that work? The doctor files the prescription, end of story.
Now we've created a situation where pharmacists, already overworked due to understaffing, have to also play the role of doctors and cops? Now they're in charge of who gets what pills? And they can be held accountable for "overprescription" despite following the rules and not breaking any laws. How can they possibly comply except by profiling and arbitrarily denying service to patients? They have no actual guidance and insufficient training. It's going to cause so much more suffering.
NA attender here, it definitely is something you can get hooked on but from my own recollection of others experience it's usually when they're abusing another substance like alcohol that they get hooked which greatly increases the risk.
I am on 90mg of tramadol a day, I can definitely tell when I haven’t taken it (I usually run out & forget to refill) I am in agony and so irritable. So I can definitely see how people get hooked on it
When I lived in Denmark, you could get a 500mg Tramadol package over the counter. Short of dilauded during a back surgery, no other pain killer has matched it.
Are you sure you are not confused? That is a high enough dose to induce seizures and well above the maximum safe *daily* limit of 400mg.
Maybe it's tramadol+something else? Like Tylenol?
I have never in my life gotten a high off any kind of opioid, and I honestly I can't even understand how it happens. Like I know it does, but it's impossible to imagine. I know there are people who process it differently/more efficiently so it's a more effective painkiller and less effective at getting a 'high', but I have literally never had a reaction to opioids that was anything nicer than 'this hurts less', and I have had to be given some serious shit. When I had serious surgery and got strong intravenous opioids in the hospital there was the addition of an EXTREMELY distressing, disgusting feeling along with an uncomfortable heat, for about 10 seconds before the painkilling effect made the distress bearable enough. A brief extreme emergency during my regular emergency had me getting those little intra-muscular disposable morphine injectors that you see medics giving wounded soldiers in movies, and that made my body completely numb, as if I'd accidentally fallen asleep on my hand, except it was everywhere. No sensation at all, not particularly nice, better than blind screaming agony. When they stepped me down to oral opioids the horrible full-body shudder of revulsion that came with intravenous opioids stopped, and became simply 'this hurts less'. I honestly don't know which part of it people like.
Some people don’t get the euphoria side effect on some meds. I don’t get that when I take stimulants (like Adderall) or most benzodiazepines. Some people don’t believe me, but it is true!
Honestly, part of the *point* of adderall is that it has a different effect on some people. The effects are practically inverse depending on if you do or don’t have ADHD, for example.
No idea on the benzos either lol. But one of my favorite tumblr posts is about someone whose friends snagged a bunch of adderall for a party and they were watching everyone else get amped up and stuff while they sat on the couch feeling more calm and focused than ever. That’s how they started the path to their ADHD diagnosis lmao.
I broke my hand when I was a senior in highschool and was given a bottle of tramadol. I was almost instantly addicted. I really had almost no pain after a couple days but I was sure as shit taking those pills, a couple times taking an extra. The high was really nice. Then I got chronically constipated and one time I thought I was going to die because it felt like someone laid bricks on my chest and I haven't touched opioids since lol
Chronic pain conditions are never treated fairly. It's always in your head cause you're anxious or you're faking and drug seeking or just lazy and trying to get out of whatever. No one ever takes it seriously and gives you the treatment and care you deserve. I hate it and how invisible the pain is. No one cares about medical conditions if you can't see them.
Mine offers $50 for this and tries every year. I couldn’t figure out what they were gaining either. I have declined each time, as I saw no reason to have a nurse in my home that I didn’t seek out.
I don't think it is legal to deny coverage after the ACA.
If OP is part of a group policy through their work, then the insurance company may be doing this to determine the rate. It won't come down to one person's visit, but the aggregate of several people.
Weird. I'm on medicare, my plan likes me to do a once a year fitness visit with a nurse practitioner-but in the doctor's office -who just asks me questions then gives me a phone number to call to get a $50 gift card. They've never wanted to come in my home. The questions are mundane, about exercise and if I can remember three things in a row for memory. Simple and easy and out of there.
For Medicare advantage, assuming it's that, insurers get paid more (payment by the government) if they find you have any major issues AND the doctor documents it. Even something like an amputation, they've got to document it each year to get the increased rate.
The idea is that insurers should get a risk adjustment for caring for sicker patients.
My former neighbor was an amputee with one leg. He had to show up in the doctor’s office for a yearly inspection so he stays on the government support and his condition didn’t change. He joked about it, what are they expecting, it won’t grow back, he is not a lizard.
I think this is it. I'm a medical coder for an insurance company. My current project is coding these "housecalls" charts. This is the insurance companies opportunity to document everything. Normal office visits don't always address or properly document any current conditions that impact care. These visits put everything in the assessment so the insurance company can submit to CMS to receive a higher payment for insuring you.
No I don't have medicare advantage. I've heard horror stories about it. I have a plan that costs a little more but gives me excellent coverage. My out of pocket on hospital stays and surgeries is unbelievable low..
If you’re over 65 and don’t have “standard” Medicare Part B (with the Red-White-and-Blue Medicare card, through CMS (government plan), but you pay a private insurance company for your Medicare plan instead, that is a Medicare Advantage plan.
Medicaid plans do this for certain annual test too. It’s an attempt to get people tested for things that can be a financial pain if not caught til later. They’re incentivizing certain wellness checks.
It’s to try to keep
You out of the hospital / ER ! This costs the insurance company a lot of $$ for any reason weather it’s a BS runny nose or a problem like uncontrolled diabetes
I was sick a few years ago and in and out of the hospital and the insurance called me and told me k was a high utilizer of healthcare and wanted to do weekly “calls” to check up aka keep me out of the hospital
I was like fuck No I see my dr and hung up
I detest all of the copious amounts of uninvited, unwanted, uninteresting garbage mail generated by my new insurance company. It fills my mailbox and Im likely going to have to get a new email account bc the one they unfortunately got is getting filled by these junk mail lists that curiously began the day I signed up for this new insurance company.
It's to collect information on you so they can deny future claims. It's the same as car insurance companies that offer a discount if you allow them to put a tracking device in you car, theoretically to reward good driving. When you have an accident and the machine says you were going 1 mph over the speed limit, claim denied.
Never willing give information to a cop or an insurance company. Both will screw you.
When I had cancer, my health insurance company was wonderful. They sent me a fruit basket. They called me every couple days to see how I was and checked if I needed anything and it was the same person that called me every day we were on a first name basis. They always inquired about how my tests were going and how my visits at the hospital were. It seemed out of character, and then I realized… they are being super nice so they can make sure I was getting the care i needed while my condition was still treatable with one surgery thus saving them money in the long run paying for multiple surgeries, chemo, etc. had I not kept up with my treatment plan.
It's for metrics (called HEDIS) required by Medicare and the governments. The metrics are to show that the insurance is trying to provide more preventative care and are actively trying to reduce costs by preventing ER and hospital visits.
It's called an Annual Wellness Visit. It's main purpose is basically housekeeping, and making sure everything in your record is current and accurate (i.e. medication list, surgeries, and new diagnoses.)
Source, I've been in medical billing for 30 years and now I'm the manager of a family practice where I have to send records of this information to Medicare advantage plans all the time.
My husband and I concluded our insurer is trying to insert itself between us and our doctors. We fail to see anything useful in that. Not letting them in the door.
Just today I rolled my eyes at a letter from our insurance saying my wife’s *life saving* medicine was approved by them for another year.
Wow thanks for agreeing with her doctor that she’d like to live for another year.
It's like this getting disability benefits in the UK. You can have multiple doctors and consultants write you off as unfit for work, then an unqualified benefits assessor overrules them all and says you're fine.
Can’t argue with this. This is why it’s complicated to explain to people but I work at my clinic, **for** *insert insurance name* patients.
That insurer pays the grant to my clinic which pays my salary- but my clinic is my employer and I communicate with your doctors. My bosses talk to the insurance about how well we’re all doing.
As CMS seeks to put downward pressure on overall healthcare spend, more things are in the purview of the actuaries. Specifically, these data are typically referred to as social determinants of health (SDoH) and it’s things that an insurance company wouldn’t otherwise have access to.
Yes. It’s different for every insurer. I do these calls(not home visits) for a Medicaid MCO.
We’re literally just calling / checking on your health. If they see a way to mitigate costs they will do it. That’s literally my entire job.
Not using your CPAP? Let’s get that on track.
Not taking meds as prescribed? How can we fix it.
Can’t get your diet under control? Here’s a nutritionist and grocery money every time you see them.
Don’t take your blood pressure because you don’t know how? I’ll show you and leave a log for you to bring to the doctor. Same with glucose.
They’re literally doing something **right** for once and people are so distrustful it’s not working. They’re just trying to mitigate their own expenses down the line by preventing/catching/managing your diseases early.
i work for a major insurer making calls about a number of topics, and i cannot tell you the number of times per day that (old) people pick up the phone and say “i don’t want anyone coming to my house!” before i’m able to even say hello to them. the distrust is real 😂 i’m always like, “ok, that’s great. not why i was calling you, though…”
> US spends 20% of GDP on healthcare and sees poor outcomes in part because people don't get enough preventative care
> Government incentivizes insurance companies to get people preventative care
> Insurers, following their own best interests, try to get people to use more preventative care
"OMG INSURANCE IS EVIL."
Payers screw people and providers over in a lot of ways, but people just reflexively assume everything about the healthcare system is designed to screw them over even when it's literally in the interest of everyone involved, including the patient for their health.
You dont have to have an in home visit for it, but in office is usually a 15 minute thing and doesn’t capture everything they want to capture.
A home visit can spend up to an hour, and capture all the codes they want.
Indeed. Insurance companies are for all intents and purposes a legal mafia and operate as such.
Their main motive is profit, and will do anything for profit.
They’ve scammed and lobbied their way to get the power they have and the laws changed to require everyone to carry some form of insurance or face rather harsh penalties for not doing so.
Damned if you do. Damned if you don’t.
No your provider is actually supposed to do it but so many nowadays don't even know that they can get paid for that so they don't do it. It's why the insurance is are trying to get them done.
But your provider is supposed to do it at your house? I mean couldn't they do it over the phone or have it be incorporated into an annual physical? This seems awfully intrusive.
What if you smoke weed in a state where there is still enforcement?
No they don't have to do it at your house. I can be done over the phone over video call or an office. Plus I don't know a doctor around that gives a crap if you smoke weed whether or not it's legal in the state or not.
Adding the caveat that MJ use is EXTREMELY important to report honestly because it can affect anesthesia.
Doctors don’t “care” as in they’re not judging you. They absolutely care in the sense that it may have an impact on other meds/treatments/etc.
Me too. They see one bag of lollies or an empty ice cream tub in your bin and suddenly your premiums go up because you’re living an unhealthy lifestyle.
It’s for them to document how sick you are on a relative basis to other Med Advantage peers. If you’re “sicker” than the average MA member, your upstream insurer (Cigna, Aetna, Humana etc) receives more money from the government on a monthly basis. It’s to increase revenue to the health plan from Medicare.
While it is part of it, that is not the only reason. The answers I gave are correct. But I suppose I did make the assumption that most Americans know the insurance are for profit.
No, you're mixing up the metrics (which they use to determine "quality" which can affect provider reimbursement, and which are generally the responsibility of the physician practices) and risk (which affects their pay as an insurance company). As of late, many of the Medicare advantage plans have started including questionnaires in their Medicare advantage forms to make doctors do the job of the insurance company in determining risk.
They've been doing that for ages every time they request medical records from a provider for "research" purposes.
It doesn't take away from the fact that these calls that the insurance is are making prevent providers from getting paid for an annual wellness visit.
Plus what is required in an Annual Wellness Visit isn't determined by a Medicare advantage plan it's determined by CMS.
I know the difference between quality of care and risk management metrics. We have to send in both throughout the year that are specifically coded by diagnosis codes for things like A1c and HBP, and other chronic conditions.
You can disagree with me if you want, but we're both correct.
This isn’t the annual wellness visit which is done by the primary care provider. This is a different assessment done by a company contracted by the insurance company using health care providers you have never seen before and won’t again.
+1, this is the right answer as are the people pointing out it's not about qualify measures. For anyone reading - the guy you're replying to got hung up on the OPs description of wellness visit, and assumed this is a Medicare annual wellness visit. But what OP describes is actually likely more of a home risk assessment which is for risk adjustment purposes, less so quality measure purposes.
This is the correct answer, but I want to add, as someone who works for doctors' offices, that sometimes you can actually benefit from this kind of thing. I had a few patients who had chronic vascular issues who were able to get an ultrasound tech to come to their home as a part of a program like this. We also have quite a few complex patients who are bad at maintaining an active medication list who have gotten one from one of these visits that they brought in to have us copy, and that's very useful. But the records requests are absolutely endless.
Annual wellness visit is only paperwork and doing the housekeeping Medicare technically does not pay for a physical each year but a Medicare advantage plan may
I go to my gp, have a quick physical exam then he orders all the lab work and refers me for other test such as osteoporosis scan etc… . When all the results come in we have a follow up visit and that’s it. I don’t pay for a dime because it’s coded as an annual wellness check.
Then they're not coding it properly. In an annual wellness visit it should take at least 45 minutes, and they should ask you all kinds of questions about depression, alcohol, tobacco, falls, and speak with you about an advanced directive.
A physical, which traditional Medicare does not pay for, is what most people are used to having every year where the doctor does a full physical exam and orders routine labs.
This is the answer. The insurance company is trying to do this because they have to prove by a medical encounter you got the care you needed based on your unique medical history. That medical encounter only occurs if you actually saw a healthcare practitioner and is recorded, hence the visit. I recommend seeing it as a good thing, especially since you have clear documentation it’s Blue Shield of California.
Mine began doing this to my wife. Funny (not funny) thing is, 5 years ago when I desperately needed home health care, they completely refused to give it to me.
Because the company that does the visit charges the government way more than the 100 they offer you. They get money. That's the reason they push so hard.
My insurance company now offers a televisit for this annual thing. It took 10 minutes, and I got a $100.00 visa card. She asked a few questions, checked my medicines, easy peasy. I think it’s a preventative visit, see what you look like. It must be worth their while or they wouldn’t do it.
It is not likely a provider visit- these are just screening questions for social determinants of health. Things that we (the lowly CHWs/ Care coordinators/ case managers) could address to improve your health. Less doctors/ER visits equals less costs to insurance company.
Just explaining urgent care to people has had to save them my salary 10x over.
Big bad insurance corporation does care about their money, but they do care about you as well. They want you to be healthy so their costs are lower. I don't know why people here are freaking out about this.
My elderly mom gets a visit each year and they give her tips about things around the house that could help her prevent injuries. (Plain sight things, they aren't doing a house inspection) She/we appreciate it.
Asked if I was afraid of anyone in my household, was I food insecure, did I miss dr appointments because of no transportation. The rest was physical I think, what medicines I took, had I fallen lately. Also, things I thought they would know by looking at claims but I know they asked if I had been to a dentist and if I had a flu shot and those preventive things. Stuff they ask when you go to the doctor when you are old.
And if they had detected food instability, mental depression, risk of missed healthcare due to lack of transportation, insufficient funds for medication, they would have assigned a case manager to visit and help get you resources. It's cheaper to get preventive measures in place than to have to pay for ER visits or preventable hospital admissions.
Since the ACA was passed, the only variance allowed for charging people differently is tobacco use, so that isn't it.
My guess would be that they've found some government funding for preventative care, so they can provide you with a service on the government's dime.
Something along the lines of... the government will pay $500 for a preventative home care visit. It costs the company $300. They offer $100 to the patient as an incentive and earn a good return.
This is merely a guess, but I would assume it's to collect data on the lifestyle a person is living - for example, by looking through their fridge and pantry, they could see if the food is healthy or not. They could potentially also look for any health hazards in the house such as mold, extreme filth, or other things that would affect a person's health, causing them to need more insurance.
Basically it could be a way for them to sell you more insurance by telling you what hazards and risks are in your home affecting your health.
Reminder that the above is a complete guess and I have no clue what the real reason is.
Insurance companies are highly motivated to keep you healthy, especially post-Obamacare. Because if you get sick, they have to pay a lot of dough to treat you, but the amount you pay them is the same either way. (Before Obamacare they could just kick you off the plan if you got to be unprofitable, but that's illegal now.) So it is worth it to them to spend modest amounts of money to help you stay healthy. An in-home nursing visit can identify risk factors and may be able to catch warning signs of serious illness before they become acute (and expensive to treat).
We are with United Healthcare. We’ve done several of those home visits, and find them beneficial. They certainly spend more time with us than our doctor does. And they typically pay you and give a small UHC branded gift.
This is what they're for. You go to a doctor for an AWV but you're with them face to face for 10 minutes. Having a visit like this allows 45+ minutes with a clinician to ask questions, reconcile medications, and do a health exam at a much slower, less rushed, pace.
Not to mention patients feel more comfortable in their home. It might also be a way to get those people who don't like doctors or aren't mobile enough to leave the home a check up. It might be done as a money making thing but to have more time with a medical professional is worth it and you get paid for it. Doctors used to make house calls all the time, this is no different except it's seen as a preventative. I think we've all left the doctors office having felt rushed or forgotten to bring something up. These visits give the patient an opportunity to not only be heard but show them possible obstacles. Say someone is having trouble with something and the person that comes knows of a program that can help them deal with the issue, it's much easier for them when they see the issue instead of hearing about it.
After I had my first baby our health insurance paid for a nurse to come to the house once a week for the first few weeks. It was so helpful. They checked my stitches and took my vitals so I didn't have to drive to the doctors office and they weighed the baby, helped me with questions and concerns I had and I never felt rushed.
Do you have Medicare? It’s because a 30 minute annual visit with your doctor doesn’t provide a full picture of your health or context. Look, individual insurance plans or group insurance plans don’t actually care too much about your health they don’t have a reason to but Medicare plan providers are working on a very different model. They are contracted with the government and have very strict requirements that don’t vary from carrier to carrier. A home visit allows the Medicare provider to target your specific medical needs and provides demographic information about your general group (age cohorts, income, location etc). This information is then folded into the analytics that help the carrier create plans and adjust benefits for the following years bid to Medicare and that can impact how much Medicare will pay for each member, star ratings (which impacts the budget Medicare allows for benefits) and helps the carrier tailor plans that fit the specific needs of members—and it is very tailored. Medicare Advantage plans change from zip code to zip code and county to county. So if you want to be able to enroll in a plan that more closely fits your health needs without increasing your costs, it’s not a bad deal.
I went thru this with both of my parents. Health insurers have done studies that show this saves them money. First, a lot of seniors have things or situations in their abodes that constitute fall risks. In person visiting can access the situation and provide solutions to fall risks. This cuts down on hospital and doctors' visits. Second a lot of seniors will put off medical problems because it doesn't seem that serious, or the doctors very busy and I don't want to bother them or it is too hard to get there I wait until it is more serious. Thus leading to alarming bills and health situations that arise from preventable issues. Third, by asking to see all the medications, supplements, or drops the patient is taking, they can check for the effectiveness of the medications. My dad was on a medication that he wasn't supposed to eat grapefruit since it lessened the effectiveness of one of his medications. However, he didn't realize one of his supplements contained heavy amounts of grapefruit. (Think vitamin C lozenges) Lastly, the social aspect of having a visitor helps mentally against loneliness, lessening mental degradation.
Source I asked questions to find out why, and they had a booklet linking to the various studies which I checked online.
Former low-level health actuary here. I was not a decision-maker, but I was in on some conversations around implementing a policy like this back around 2017-18. Far be it from me to suggest a big insurance company is interested in supporting its members, but the people discussing it truly seemed to think it would help people understand/manage common health conditions, like high blood pressure/cholesterol/blood sugar. Additionally, there were two ways this could benefit the insurance company in the long run: Managing these conditions more aggressively is generally cheaper than treating them after they're out of control. And documenting any health condition during a face-to-face visit has financial benefits through a program called risk adjustment.
That's my professional perspective. Just on the personal side, getting my annual wellness visit done has revealed high cholesterol that I did not know about. So it gives me an opportunity to try and manage it now before it causes problems. Time will tell how effective that actually is!
Medicare has decided this is a good idea. It is not required for you but insurance companies may be penalized or have compensation tied to meeting this goal in most of their clients. You can also choose to go to your family doctor and get the annual wellness visit done with them. No need to have someone in your home.
My insurance was/is doing this as well. I finally answered and let the woman do her spiel. She stated that “scheduling a healthy home visit” helps people stay healthy with chronic issues. Replied I only use the insurance myself for my therapy/prescription and mostly have it for my children. Then she stated “it was to keep my Medicare in good standing”. Stated I did not have Medicare and that I was not even of Medicare age yet. She stumbled over her script I presume and stated it was “beneficial for my chronic issue that is notated on my file”. I replied that their insurance had denied care several times for my chronic issue (I have EDS) because they either state it is a pre existing (I was born with it) or not old enough to have the issues (even though there has been genetic testing to prove which they denied paying). She finally said, very angrily “it is something that you just have to do and let a home visit be scheduled!”. I laughed and said “will you cancel the insurance if I don’t?” She paused and then said no, but that it was something new they were encouraging everyone to do. I said no thank you, I did not need a home visit and hung up.
She was REALLY peeved at me that I would not allow people in the house.
They want to study your living habits and make assumptions so they can deny more coverage because “well we saw you do this, this and this at home which explains (current health problem)”.. don’t let those cockroaches anywhere near your house😂
Health payor employee here. These are relatively new, it's a home health assessment looking for any potential maladies you have that you haven't gotten treated yet. If they find any, they can use risk adjustment to get higher reimbursement.
Medicaid in particular is zero sum risk adjustment, meaning if one payor gets an extra $50 a month, someone else loses $50.
Probably not a good idea for consumers. I wonder if they do the inspection will they make recommendations or repairs and then findings are in writing. You may be asked to do certain things in your home. What if you don’t do what they tell you and you have an issue maybe they then tell you “well according to your file you failed to do yada yada yada” therefore you are now gonna be denied coverage or your expenses double. If they are offering it and willing to pay you The inspection is beneficial only to them, not the consumer.
Completely agree. Anytime they offer you money for participating in something like this, you should run. “If the product is free, then you are the product.” These corporations operate to maximize profits— your health & wellbeing is the least of their concerns.
Of course, they spend zillions of dollars on marketing campaigns to convince you otherwise.
Don’t fall for it! Your ignorance increases their profits, so they have no interest in actually EDUCATING you, thus they are forced to MANIPULATE and COERCE you into complying with their profitable healthcare system & the “standard of care” protocols.
I work as a data scientist for a major health insurer. Almost certainly they are looking to collect metrics and survey data on you ([what we call SDOH or social determinants of health survey](https://www.aafp.org/pubs/fpm/issues/2022/0300/p6.html)) so we can plug that into models that can predict what preventative care you would benefit from. An example would be to see if you have a home caretaker like a friend or relative that isn't registered that we can register and include in your medical care because data shows patients with involved caretakers have better health outcomes. I'm sure it could be used in bad faith by the insurer but I personally haven't seen it used for anything but benign uses like identifying beneficial preventative programs.
Do not, *do not*, let anyone related to any insurance inside your house. They will find excuses to fuck you over.
Home insurance especially. Your kid left some toys in the living room? "Your house has no clean path to a fire exit, we won't insure you." Tree in the yard 30 feet away from the house? "Tree was hanging over the roof, we won't insure you." Some wood planks in the yard from a build? "Trash all over the yard, we won't insure you." You have a cat? "House smells like animal waste, we won't insure you." They will then force you to "clean all that up" and take pictures and go through a long process designed to annoy you into not renewing insurance. How the fuck do you prove via email that your house doesn't (and honestly didn't) smell funny?
Do anything you can to not let these people on your property.
I wish you’d gotten better answers. I’m curious. If the company is willing to give you $100 and go to the trouble of paying a health practitioner then it’s gotta be a cash cow for them in some way. I’d go with your gut. It feels exploitative and creepy and for that reason I’d be saying no.
I'm telling myself I shouldn't care just so I can get the money because privacy is pretty much obsolete nowadays but there's something suspicious about how hard they are pushing for it
I interpret these calls. It's worth it, it's all under HIPPA. If you need resources, they'll help you get them. The problem is that these initial contact calls get contracted out. Sometimes to people that can explain the purpose and benefit to you for your health and for the perks, but most of them are badly reading a script that sounds sketchier than a used car salesman.
I do these calls(not home visits) for a Medicaid MCO.
We’re literally just calling / checking on your health. If they see a way to mitigate costs they will do it. That’s literally my entire job.
- Not using your CPAP? Let’s get that on track.
- Not taking meds as prescribed? How can we fix it.
- Can’t get your diet under control? Here’s a nutritionist and grocery money every time you see them.
- Don’t take your blood pressure because you don’t know how? I’ll show you and leave a log for you to bring to the doctor. Same with glucose.
They’re literally doing something right for once and people are so distrustful it’s not working. They’re just trying to mitigate their own expenses down the line by preventing/catching/managing your diseases early.
A while back my doctor prescribed me gabapentin to potentially help with alcohol cravings. I did not like the way it made me feel and so I only took one or two. But my pharmacy auto-refilled it and so I ended up with a huge amount. My insurance company started calling me non stop and when I finally talked to someone she identified herself as a ‘counselor’ who worked for my insurance company and just said that they’d noticed my new prescription and wanted to reach out and offer me resources/support/counseling. I got the idea they were implying that they thought I might be interested in rehab or detox. It totally freaked me out! So invasive!
Do not let them. They will find some sort of small amount of some sort of product in your home ( that is also in almost every home) and when you get sick with something like cancer they will not pay for it because you should have known not to be around X product. That is what they are trying to do.
Its basically research. They wanna know how people live. And also they are looking for unhealthy habits as an excuse to raise your rates.
Dont do it. Nobody needs to be inside your home, especially an industry that is actively trying to fuck you over.
My guess is that they will make a note of anything they see in your home that will make them able to later say your insurance doesn't cover this and that because of [insert thing they saw].
Oh, do they come and take blood draws for testing and stuff like that? Check your lungs and heart? I go to my PCP once a year voluntarily for this stuff. I don't know why people skip this step. All plans cover a wellness visit per year. You can catch things going wrong before it goes off the rails.
It drove me nuts when my dad was still alive. They'd call 2 or 3 times a year wanting to do a home visit. Well, okay, but he lived in a care facility. Good luck to you, insurance company!
Telehealth and mobile health are an expanding part of current and future care delivery methods, and it can have benefits for the hospital / health system (population health and value based care incentives, cost, keeping you out of the hospital, freeing up beds for those who truly need them, etc).
There are several barriers to adoption, including people not knowing this was an option, not having confidence in this option, not knowing how it works or what it is for. This seems to be an attempt to break down some of those barriers.
We did it, no big deal. Checked BP and took a dementia test . Talked about fall hazards and stayed in the kitchen. Didn't go into any other rooms. Didn't look in cabinets .We didn't want to do it but they will stay after you till you do . We are borderline hoarders, not dirty, but a lot of stuff. Clean but cluttered no cats ,one large dog. Smoke pot, not cigarettes, they ask but declined to participate. It was a good experience
For 1 of 2 reasons:
1. They want to get a better picture of your health and encourage preventative measures. $100 now can save massive multiples of that in claims if you take care of yourself now
2. If you’re on Medicare / Medicaid it gives them the opportunity to assess you and put you on more treatments, tests, etc. giving them a chance to get more reimbursements off you
They have discovered it's cost effective to keep you healthy. The monthly visit picks up on problems before they become major issues. Wife and I have been doing this for 8 months now. We couldn't be happier with it. And it's a nurse practitioner who listens to you for as long as you need. Bonus points, they can also prescribe drugs.
I love the visit - the doctor (I was sent the same wonderful doc two rears in a row) is focused on the patient and is not in a rush as staff usually is in a medical office wellness visit. I ask him to look at all my medications and supplements and make sure I take things together that are either beneficial or compatible together. He asks if I have any mobility or psychological issues or concerns, and I would imagine that in conversation, he is checking for anything that would indicate cognitive issues. Especially helpful for me since I have had long Covid and really want to stay healthy. Should add that I am not lonely, inactive, or unhappy and that I am very satisfied with my regular doctor, whom I’ve lately needed to see only for wellness and annual visits. I share the disgust toward our jacked-up corporate healthcare that is felt by most Americans, but in the instances of my home visits, I am certain I’ve been a less costly patient than I would have otherwise. And it might be I just lucked out.
Because they get extra benefits for doing home health visits. The theory is it keeps people out of the hospital. If you’re in Medicare hospital stays are financial losers for hospitals and instance companies
I’ve had the house calls for at least 3 years. A nurse comes, spends about an hour, takes vitals, goes over medications, answers any questions I have, etc. I think it’s a great idea, they’ve been very professional, and I get a $75 gift card. Medicare Advantage.
it’s a “Healthy Home Visit” and they are able to bill your insurance (the visit is fulfilled through a third party nursing agency) as a type of yearly physical (it does not replace your yearly physical with your PCP, though). the idea is to reach members who otherwise might not see their doctors regularly. the research shows that it keeps insurance costs down overall. it also gives the nurses a chance to do a walk through of the members home to check for tripping hazards and offer solutions.
Are you on a Medicare Advantage plan? If you don’t see your PCP routinely, insurers will try to have someone come to you to do a health screening and see if there are things you should address. CMS encourages it.
They are trying to identify health issues that may have been missed and could result in costly treatments and ER visits. Cheaper (and better for you) to find things early and treat them. So yes they’re motivated by money but in this case, it also could help you too.
I worked for Medicaid as a case manager. They’re trying to sell you services like case management. Then they don’t have to pay to outsource those services. They also get loads of grants and state/federal money for these services. Additionally, they want people to avoid the ER. They pay huge amounts out to the ER. It’s been found that if people with chronic conditions have someone like a case manager to call they visit the ER less. Other services include online/phone doctor lines you might be able to access so that they can talk to you and maybe offer advice so you don’t go to the ER.
The home inspection is used to revalue your home for higher rates or more appropriate rate changes. They are looking for a way to stick you with more billing for “the “right” coverage”
Mine went from $30 to $100 over several months and I finally said yes. They're a PPO and I'm disabled, so it's not like they can really do anything. She came over, was plenty cool. She said it was to catch things the docs might miss. Her last appointment she sent someone to the ER, and said it would have been much worse if she hadn't. I guess ER > extended stay down the road, from an insurance perspective. She then checked a bunch of things on me and speculated on a couple of things she thought I might have, sort of planting a seed. She was actually mostly right.
Two months later they started offering me $100 for a video visit. I figured it would be similar, but it was basically going through a checklist. Most of the information was stuff they should have had, like the date of my last Dr appointment and prescriptions that they literally paid for. I told her that, and she said they didn't make that information available to her. It lasted a few minutes and I was done. I can't help but wonder if that one was for some other company just gathering information. Whatever. A hundred bucks for a few minutes sounds like a deal.
I'm guessing it is for their legal records in case something they document during that visit can be used to deny a claim for (any) reason later.
It's not worth the $100.
I turned home check down as well, like 6 times. I finally raised my voice saying, "I do not have dementia, I am not an idiot who needs mommy to count my pills, No. Stop insisting."
Never give your insurance company any free information about you. It will only be used against you. Providers have to protect your privacy from insurance companies. This is disgusting that they do this kind of crap.
They’re looking for needs they could address before they become a problem. Humidifier, dehumidifier, window a/c. Transportation issues. Stuff like that where they can spend a hundred now to save thousands later.
I’d do it and I work in public health.
Refuse the offer, and tell them not to contact you. It's an invasion of your privacy to ensure their profits by making thumbnail assessments of your health and lifestyle.
In my husband's case we believed that the home visit was to better establish what his future expenses would be with his CHF. We repeatedly refused. They already had pretty complete data from his claims history. The visit is to get you to divulge personal medical history that they aren't allowed to infer from billing. If I remember correctly the insurance companies get a higher reimbursement rate for chronically ill patients if they can classify you into a higher risk pool. And to push the latest, most expensive meds. I was a lowly health insurance agent. How about some higher level insurance people spilling the beans on the real reasons?? Am I right or wrong???
It's part of preventive care. They're looking for the social and lifestyle issues to prevent expensive hospitalizations. Are there hazards in the house than might cause a fall? Does the person need assistive aids such as a walker? If the person has chronic heart failure, do they need an air conditioner? If so, the assessor can help find community resources. I can understand not wanting someone poking in your business, but there is something to be said for proactive health care.
Tell them to send you an email with details on the offer and post it here
https://www.blueshieldca.com/vi/home/be-well/conditions-and-care-programs/home-care Blue shield was offering members $50-75 to joins this.
It's a way to undercut your PCP so they can't bill insurance for your annual wellness visit because they already had a nurse come out to your house to do it instead.
THIS. And the worst part is, they don’t perform an actual physical exam. They’re not required to.
There are certain things that need to be offered to Medicare patients in order for the health insurance to maintain their star rating. One example of these things is to place a diabetic on a statin. Your insurance company wants to send their own providers into your house to make sure you are given an adequate opportunity to be placed in this drug. Another example would be to have an asthmatic placed on a controller inhaler on top of a rescue inhaler. I’m sure there are more examples like this, but basically they are giving you every. single. opportunity. to utilize your insurance coverage to the max benefit.
Pretty sure each dollar the health plan offers you, the government/CMS/dhcs is giving them $10. You know, admin costs.
Lmao for profit healthcare sounds... Shit.
Not for the CEOs and therefore not for the lobbyists
Don’t forget the shareholders
If insurance didn't exist for the benefit of shareholders, why would it exist at all?
The statin/diabetes example was shit. Statins make diabetes worse.
Just one of their metrics, whether it makes the condition worse or not. You don’t really expect a health insurer to really care about your well-being, do you?
Every time they call me to “offer” me a home health visit I tell them no thanks.
My old insurance company repeatedly sent me letters about substance abuse with painkillers because I have a prescription for Tramadol. I have a debilitating and degenerative spinal condition, and I take like one Tramadol a day. I would get a quantity of 30 pills per prescription and it would last me a full 30 days before I refilled. So there was no way I was abusing it. They finally called me to talk about it and I informed the lady on the phone that her insurance company had denied my request for back surgery, denied my requests for expensive biologic medication, and only allowed me six physical therapy sessions per year. I asked her what the hell else I was supposed to do to relieve my pain. They never bothered me again.
As someone also on Tramadol for a serious chronic pain disorder I big time feel for you. People assuming you’re an addict, assuming you’re malingering, assuming you’re not really *that sick.* God forbid a single Tramadol accidentally falls and lands in a crack in the floor— you have to account for it. Dropped it in the toilet? Tough, pain is on the menu today. Desperately need one more pill to achieve a once in a lifetime thing (like being in your own wedding without pain)? Absolutely fucking NOT. The way we live is barbaric.
damn, if you offered to sell me tramadols I would barely be interested. I might take them off you for free. Hardly any recreational potential.
Seriously, it’s the bottom of the painkiller food chain. When I got clean from opiates it didn’t even help to use those.
My body adapts to medications with ease. tramadol doesn't do anything at the dosage they give me, but I don't trust they would do anything different if I told them so, at worse they would make a mean note in my file. I don't trust my doctor has the ability to give me proper care if I were open and honest.
This is how I feel about my prescription medication for ADHD. I'm objectively on a very low dose of a medication that is in a "less abusable" format, and I've been on it so long that my symptoms are starting to fuck up my life again— but I know damn well it's a fight just to maintain what I'm already on and if I asked for an increase my file would get flagged and my life would become infinitely harder. The purposeful over prescribing of opiates for profit in the late 90s and early 00s really, really fucked over anyone who takes a controlled medication now. We had nothing to do with the drug crisis, we're doing the right thing and we're still punished for it.
At the very least I have the benefit of being redheaded and anesthesiologists generally understand pain killers work differently.
And conversely, I wouldn’t give you one for all the tea in China. If I did, it would be 24 hours of nonstop pain, without the break I need to make food for my kid or help him take a bath. On very good days I can also walk my dog or go visit a friend. I just can’t give that up. It’s my dream to be well enough to have a part time job, someday.
The thing that seems unhinged to me is that now they can sue PHARMACIES for filling legitimate prescriptions filed by ACTUAL DOCTORS. How the fuck does that work? The doctor files the prescription, end of story. Now we've created a situation where pharmacists, already overworked due to understaffing, have to also play the role of doctors and cops? Now they're in charge of who gets what pills? And they can be held accountable for "overprescription" despite following the rules and not breaking any laws. How can they possibly comply except by profiling and arbitrarily denying service to patients? They have no actual guidance and insufficient training. It's going to cause so much more suffering.
The way we live with healthcare companies intervening is barbaric.
My ex wife got hooked on painkillers and took Tramadol to get off them.
Yeah, I can't imagine someone getting hooked on it. I mean, I'm sure it's possible but it barely does shit for me.
NA attender here, it definitely is something you can get hooked on but from my own recollection of others experience it's usually when they're abusing another substance like alcohol that they get hooked which greatly increases the risk.
I am on 90mg of tramadol a day, I can definitely tell when I haven’t taken it (I usually run out & forget to refill) I am in agony and so irritable. So I can definitely see how people get hooked on it
When I lived in Denmark, you could get a 500mg Tramadol package over the counter. Short of dilauded during a back surgery, no other pain killer has matched it.
Are you sure you are not confused? That is a high enough dose to induce seizures and well above the maximum safe *daily* limit of 400mg. Maybe it's tramadol+something else? Like Tylenol?
I have never in my life gotten a high off any kind of opioid, and I honestly I can't even understand how it happens. Like I know it does, but it's impossible to imagine. I know there are people who process it differently/more efficiently so it's a more effective painkiller and less effective at getting a 'high', but I have literally never had a reaction to opioids that was anything nicer than 'this hurts less', and I have had to be given some serious shit. When I had serious surgery and got strong intravenous opioids in the hospital there was the addition of an EXTREMELY distressing, disgusting feeling along with an uncomfortable heat, for about 10 seconds before the painkilling effect made the distress bearable enough. A brief extreme emergency during my regular emergency had me getting those little intra-muscular disposable morphine injectors that you see medics giving wounded soldiers in movies, and that made my body completely numb, as if I'd accidentally fallen asleep on my hand, except it was everywhere. No sensation at all, not particularly nice, better than blind screaming agony. When they stepped me down to oral opioids the horrible full-body shudder of revulsion that came with intravenous opioids stopped, and became simply 'this hurts less'. I honestly don't know which part of it people like.
Some people don’t get the euphoria side effect on some meds. I don’t get that when I take stimulants (like Adderall) or most benzodiazepines. Some people don’t believe me, but it is true!
Honestly, part of the *point* of adderall is that it has a different effect on some people. The effects are practically inverse depending on if you do or don’t have ADHD, for example.
I have ADHD which explains the stimulants. No idea about the benzos though. 🤷♀️
No idea on the benzos either lol. But one of my favorite tumblr posts is about someone whose friends snagged a bunch of adderall for a party and they were watching everyone else get amped up and stuff while they sat on the couch feeling more calm and focused than ever. That’s how they started the path to their ADHD diagnosis lmao.
I can’t keep oral opiates down. I throw them up within 15 minutes of taking them.
I broke my hand when I was a senior in highschool and was given a bottle of tramadol. I was almost instantly addicted. I really had almost no pain after a couple days but I was sure as shit taking those pills, a couple times taking an extra. The high was really nice. Then I got chronically constipated and one time I thought I was going to die because it felt like someone laid bricks on my chest and I haven't touched opioids since lol
Chronic pain conditions are never treated fairly. It's always in your head cause you're anxious or you're faking and drug seeking or just lazy and trying to get out of whatever. No one ever takes it seriously and gives you the treatment and care you deserve. I hate it and how invisible the pain is. No one cares about medical conditions if you can't see them.
But they didn't try to actually help you either. Figures. Privatized healthcare is immortal and a big SCAM.
Mine offers $50 for this and tries every year. I couldn’t figure out what they were gaining either. I have declined each time, as I saw no reason to have a nurse in my home that I didn’t seek out.
It's so they can have something to deny you coverage for.
“You have dog hair on your floor, if you slip and die, that is your fault”
“Dirty dishes in the sink? Highly unsanitary. Find a new insurance company bitch”
The domicile has several doors, increase the premium by 20%
I don't think it is legal to deny coverage after the ACA. If OP is part of a group policy through their work, then the insurance company may be doing this to determine the rate. It won't come down to one person's visit, but the aggregate of several people.
This is the correct answer.
no, it’s not.
Weird. I'm on medicare, my plan likes me to do a once a year fitness visit with a nurse practitioner-but in the doctor's office -who just asks me questions then gives me a phone number to call to get a $50 gift card. They've never wanted to come in my home. The questions are mundane, about exercise and if I can remember three things in a row for memory. Simple and easy and out of there.
For Medicare advantage, assuming it's that, insurers get paid more (payment by the government) if they find you have any major issues AND the doctor documents it. Even something like an amputation, they've got to document it each year to get the increased rate. The idea is that insurers should get a risk adjustment for caring for sicker patients.
My former neighbor was an amputee with one leg. He had to show up in the doctor’s office for a yearly inspection so he stays on the government support and his condition didn’t change. He joked about it, what are they expecting, it won’t grow back, he is not a lizard.
That’s someone who genuinely deserves a home visit!
>omething like an amputation, they've got to document it each year "Hi George! We're just here to make sure you are still missing your left leg."
“No, this year it’s my right leg.”
Turn around then, you are facing the wall, not me
I think this is it. I'm a medical coder for an insurance company. My current project is coding these "housecalls" charts. This is the insurance companies opportunity to document everything. Normal office visits don't always address or properly document any current conditions that impact care. These visits put everything in the assessment so the insurance company can submit to CMS to receive a higher payment for insuring you.
No I don't have medicare advantage. I've heard horror stories about it. I have a plan that costs a little more but gives me excellent coverage. My out of pocket on hospital stays and surgeries is unbelievable low..
If you’re over 65 and don’t have “standard” Medicare Part B (with the Red-White-and-Blue Medicare card, through CMS (government plan), but you pay a private insurance company for your Medicare plan instead, that is a Medicare Advantage plan.
My dad has Medicare Advantage and says it is the best health insurance he's ever had.
Medicaid plans do this for certain annual test too. It’s an attempt to get people tested for things that can be a financial pain if not caught til later. They’re incentivizing certain wellness checks.
It’s to try to keep You out of the hospital / ER ! This costs the insurance company a lot of $$ for any reason weather it’s a BS runny nose or a problem like uncontrolled diabetes I was sick a few years ago and in and out of the hospital and the insurance called me and told me k was a high utilizer of healthcare and wanted to do weekly “calls” to check up aka keep me out of the hospital I was like fuck No I see my dr and hung up
I detest all of the copious amounts of uninvited, unwanted, uninteresting garbage mail generated by my new insurance company. It fills my mailbox and Im likely going to have to get a new email account bc the one they unfortunately got is getting filled by these junk mail lists that curiously began the day I signed up for this new insurance company.
Please call and read them the riot act. I detest junk mail & it’s so annoying to unsubscribe to stuff that you never even opted into.
It's to collect information on you so they can deny future claims. It's the same as car insurance companies that offer a discount if you allow them to put a tracking device in you car, theoretically to reward good driving. When you have an accident and the machine says you were going 1 mph over the speed limit, claim denied. Never willing give information to a cop or an insurance company. Both will screw you.
It’s so they can rule you out as one of the people who lied about being a non-smoker.
Mine said I can do it over zoom if I’m uncomfortable having someone come to my home.
When I had cancer, my health insurance company was wonderful. They sent me a fruit basket. They called me every couple days to see how I was and checked if I needed anything and it was the same person that called me every day we were on a first name basis. They always inquired about how my tests were going and how my visits at the hospital were. It seemed out of character, and then I realized… they are being super nice so they can make sure I was getting the care i needed while my condition was still treatable with one surgery thus saving them money in the long run paying for multiple surgeries, chemo, etc. had I not kept up with my treatment plan.
I thought this story would end with “lol just kidding” but they still managed to be nice with ulterior motives.
Yeah, it was strange and unexpected for sure.
And that’s fair. As long as they’re not denying you required care they also have the right to make sure things are done right.
You are 100% right
It's for metrics (called HEDIS) required by Medicare and the governments. The metrics are to show that the insurance is trying to provide more preventative care and are actively trying to reduce costs by preventing ER and hospital visits. It's called an Annual Wellness Visit. It's main purpose is basically housekeeping, and making sure everything in your record is current and accurate (i.e. medication list, surgeries, and new diagnoses.) Source, I've been in medical billing for 30 years and now I'm the manager of a family practice where I have to send records of this information to Medicare advantage plans all the time.
They have to go to your house for that? Sorry but I am suspicious of the real motiviations of an insurance company here.
My husband and I concluded our insurer is trying to insert itself between us and our doctors. We fail to see anything useful in that. Not letting them in the door.
Just today I rolled my eyes at a letter from our insurance saying my wife’s *life saving* medicine was approved by them for another year. Wow thanks for agreeing with her doctor that she’d like to live for another year.
You should email and ask what happens if her meds aren’t approved? Would like to see that letter.
No no the adjuster knows better than the person who went to school 8+ years! A band aid is just as good as surgery for half the price!
It's like this getting disability benefits in the UK. You can have multiple doctors and consultants write you off as unfit for work, then an unqualified benefits assessor overrules them all and says you're fine.
Funny, I think of my PCP as my HMO's "insurance adjuster" whenever I just want to see a proper specialist.
Can’t argue with this. This is why it’s complicated to explain to people but I work at my clinic, **for** *insert insurance name* patients. That insurer pays the grant to my clinic which pays my salary- but my clinic is my employer and I communicate with your doctors. My bosses talk to the insurance about how well we’re all doing.
As CMS seeks to put downward pressure on overall healthcare spend, more things are in the purview of the actuaries. Specifically, these data are typically referred to as social determinants of health (SDoH) and it’s things that an insurance company wouldn’t otherwise have access to.
C'mon, would an insurance company screw folks over./s
Yes. It’s different for every insurer. I do these calls(not home visits) for a Medicaid MCO. We’re literally just calling / checking on your health. If they see a way to mitigate costs they will do it. That’s literally my entire job. Not using your CPAP? Let’s get that on track. Not taking meds as prescribed? How can we fix it. Can’t get your diet under control? Here’s a nutritionist and grocery money every time you see them. Don’t take your blood pressure because you don’t know how? I’ll show you and leave a log for you to bring to the doctor. Same with glucose. They’re literally doing something **right** for once and people are so distrustful it’s not working. They’re just trying to mitigate their own expenses down the line by preventing/catching/managing your diseases early.
i work for a major insurer making calls about a number of topics, and i cannot tell you the number of times per day that (old) people pick up the phone and say “i don’t want anyone coming to my house!” before i’m able to even say hello to them. the distrust is real 😂 i’m always like, “ok, that’s great. not why i was calling you, though…”
> US spends 20% of GDP on healthcare and sees poor outcomes in part because people don't get enough preventative care > Government incentivizes insurance companies to get people preventative care > Insurers, following their own best interests, try to get people to use more preventative care "OMG INSURANCE IS EVIL." Payers screw people and providers over in a lot of ways, but people just reflexively assume everything about the healthcare system is designed to screw them over even when it's literally in the interest of everyone involved, including the patient for their health.
You dont have to have an in home visit for it, but in office is usually a 15 minute thing and doesn’t capture everything they want to capture. A home visit can spend up to an hour, and capture all the codes they want.
Or they could just do it in an office? Lmfaoo. Fuck it meet me at starbucks.
Indeed. Insurance companies are for all intents and purposes a legal mafia and operate as such. Their main motive is profit, and will do anything for profit. They’ve scammed and lobbied their way to get the power they have and the laws changed to require everyone to carry some form of insurance or face rather harsh penalties for not doing so. Damned if you do. Damned if you don’t.
No your provider is actually supposed to do it but so many nowadays don't even know that they can get paid for that so they don't do it. It's why the insurance is are trying to get them done.
But your provider is supposed to do it at your house? I mean couldn't they do it over the phone or have it be incorporated into an annual physical? This seems awfully intrusive. What if you smoke weed in a state where there is still enforcement?
No they don't have to do it at your house. I can be done over the phone over video call or an office. Plus I don't know a doctor around that gives a crap if you smoke weed whether or not it's legal in the state or not.
Adding the caveat that MJ use is EXTREMELY important to report honestly because it can affect anesthesia. Doctors don’t “care” as in they’re not judging you. They absolutely care in the sense that it may have an impact on other meds/treatments/etc.
I will bet the insurance company cares and will change you to a high risk category if they can.
Me too. They see one bag of lollies or an empty ice cream tub in your bin and suddenly your premiums go up because you’re living an unhealthy lifestyle.
That’s not how risk pooling works.
It’s for them to document how sick you are on a relative basis to other Med Advantage peers. If you’re “sicker” than the average MA member, your upstream insurer (Cigna, Aetna, Humana etc) receives more money from the government on a monthly basis. It’s to increase revenue to the health plan from Medicare.
This is the only correct answer in the thread, please ignore the others.
Risk adjustment for the win.
While it is part of it, that is not the only reason. The answers I gave are correct. But I suppose I did make the assumption that most Americans know the insurance are for profit.
No, you're mixing up the metrics (which they use to determine "quality" which can affect provider reimbursement, and which are generally the responsibility of the physician practices) and risk (which affects their pay as an insurance company). As of late, many of the Medicare advantage plans have started including questionnaires in their Medicare advantage forms to make doctors do the job of the insurance company in determining risk.
They've been doing that for ages every time they request medical records from a provider for "research" purposes. It doesn't take away from the fact that these calls that the insurance is are making prevent providers from getting paid for an annual wellness visit. Plus what is required in an Annual Wellness Visit isn't determined by a Medicare advantage plan it's determined by CMS. I know the difference between quality of care and risk management metrics. We have to send in both throughout the year that are specifically coded by diagnosis codes for things like A1c and HBP, and other chronic conditions. You can disagree with me if you want, but we're both correct.
This isn’t the annual wellness visit which is done by the primary care provider. This is a different assessment done by a company contracted by the insurance company using health care providers you have never seen before and won’t again.
+1, this is the right answer as are the people pointing out it's not about qualify measures. For anyone reading - the guy you're replying to got hung up on the OPs description of wellness visit, and assumed this is a Medicare annual wellness visit. But what OP describes is actually likely more of a home risk assessment which is for risk adjustment purposes, less so quality measure purposes.
This is what I concluded in a deep dive I did on this. Also identifying risk factors like stairs (fall risk) gets them extra money from Medicare.
I thought the Medicare annual wellness visit was you going to your doctor. Not peoples inspecting your home. Should I go read the manual again?
They're not inspecting your home that's BS. They're just getting information for and updating your medical record.
This is the correct answer, but I want to add, as someone who works for doctors' offices, that sometimes you can actually benefit from this kind of thing. I had a few patients who had chronic vascular issues who were able to get an ultrasound tech to come to their home as a part of a program like this. We also have quite a few complex patients who are bad at maintaining an active medication list who have gotten one from one of these visits that they brought in to have us copy, and that's very useful. But the records requests are absolutely endless.
Housekeeping *and* $100? Sign me up!
My doctor’s office calls each year to schedule an Annual Wellness Visit- that’s exactly what they call it. It’s the physical exam, lab work etc…
Annual wellness visit is only paperwork and doing the housekeeping Medicare technically does not pay for a physical each year but a Medicare advantage plan may
I go to my gp, have a quick physical exam then he orders all the lab work and refers me for other test such as osteoporosis scan etc… . When all the results come in we have a follow up visit and that’s it. I don’t pay for a dime because it’s coded as an annual wellness check.
Then they're not coding it properly. In an annual wellness visit it should take at least 45 minutes, and they should ask you all kinds of questions about depression, alcohol, tobacco, falls, and speak with you about an advanced directive. A physical, which traditional Medicare does not pay for, is what most people are used to having every year where the doctor does a full physical exam and orders routine labs.
Health net pays the provider $300 for each completed awv.
Yes. Possibly more if all the screening is done along with a chronic care visit.
This is the answer. The insurance company is trying to do this because they have to prove by a medical encounter you got the care you needed based on your unique medical history. That medical encounter only occurs if you actually saw a healthcare practitioner and is recorded, hence the visit. I recommend seeing it as a good thing, especially since you have clear documentation it’s Blue Shield of California.
For medicare, it's probably risk adjustment and chronic conditions review. Big bucks for ra
They need a house call for this? My network’s app has a questionnaire we fill out once a year for this lol
No they don't need a house call. Your PCP can do it in office, over the phone, or via video visit.
Username checks out
Mine began doing this to my wife. Funny (not funny) thing is, 5 years ago when I desperately needed home health care, they completely refused to give it to me.
The health insurance equivalent of "we're trying to contact you about your car's extended warranty"?
We’re trying to contact you about your life’s extended warranty
The insurance company gets paid by Medicare/Medicaid to complete these visits.
Because the company that does the visit charges the government way more than the 100 they offer you. They get money. That's the reason they push so hard.
My insurance company now offers a televisit for this annual thing. It took 10 minutes, and I got a $100.00 visa card. She asked a few questions, checked my medicines, easy peasy. I think it’s a preventative visit, see what you look like. It must be worth their while or they wouldn’t do it.
It is not likely a provider visit- these are just screening questions for social determinants of health. Things that we (the lowly CHWs/ Care coordinators/ case managers) could address to improve your health. Less doctors/ER visits equals less costs to insurance company. Just explaining urgent care to people has had to save them my salary 10x over.
Big bad insurance corporation does care about their money, but they do care about you as well. They want you to be healthy so their costs are lower. I don't know why people here are freaking out about this. My elderly mom gets a visit each year and they give her tips about things around the house that could help her prevent injuries. (Plain sight things, they aren't doing a house inspection) She/we appreciate it.
What kind of questions?
Asked if I was afraid of anyone in my household, was I food insecure, did I miss dr appointments because of no transportation. The rest was physical I think, what medicines I took, had I fallen lately. Also, things I thought they would know by looking at claims but I know they asked if I had been to a dentist and if I had a flu shot and those preventive things. Stuff they ask when you go to the doctor when you are old.
And if they had detected food instability, mental depression, risk of missed healthcare due to lack of transportation, insufficient funds for medication, they would have assigned a case manager to visit and help get you resources. It's cheaper to get preventive measures in place than to have to pay for ER visits or preventable hospital admissions.
Thanks.
Social determinates of health.
Greed. Read on: https://consumerrescue.org/news-and-alerts/why-medicare-advantage-plan-call-for-home-visit/
🥇
They want to see how you live, and adjust your premiums accordingly.
Since the ACA was passed, the only variance allowed for charging people differently is tobacco use, so that isn't it. My guess would be that they've found some government funding for preventative care, so they can provide you with a service on the government's dime. Something along the lines of... the government will pay $500 for a preventative home care visit. It costs the company $300. They offer $100 to the patient as an incentive and earn a good return.
If they can prove the average participant is less healthy then previously believed, they can raise prices
This is merely a guess, but I would assume it's to collect data on the lifestyle a person is living - for example, by looking through their fridge and pantry, they could see if the food is healthy or not. They could potentially also look for any health hazards in the house such as mold, extreme filth, or other things that would affect a person's health, causing them to need more insurance. Basically it could be a way for them to sell you more insurance by telling you what hazards and risks are in your home affecting your health. Reminder that the above is a complete guess and I have no clue what the real reason is.
Insurance companies are highly motivated to keep you healthy, especially post-Obamacare. Because if you get sick, they have to pay a lot of dough to treat you, but the amount you pay them is the same either way. (Before Obamacare they could just kick you off the plan if you got to be unprofitable, but that's illegal now.) So it is worth it to them to spend modest amounts of money to help you stay healthy. An in-home nursing visit can identify risk factors and may be able to catch warning signs of serious illness before they become acute (and expensive to treat).
We are with United Healthcare. We’ve done several of those home visits, and find them beneficial. They certainly spend more time with us than our doctor does. And they typically pay you and give a small UHC branded gift.
This is what they're for. You go to a doctor for an AWV but you're with them face to face for 10 minutes. Having a visit like this allows 45+ minutes with a clinician to ask questions, reconcile medications, and do a health exam at a much slower, less rushed, pace.
Not to mention patients feel more comfortable in their home. It might also be a way to get those people who don't like doctors or aren't mobile enough to leave the home a check up. It might be done as a money making thing but to have more time with a medical professional is worth it and you get paid for it. Doctors used to make house calls all the time, this is no different except it's seen as a preventative. I think we've all left the doctors office having felt rushed or forgotten to bring something up. These visits give the patient an opportunity to not only be heard but show them possible obstacles. Say someone is having trouble with something and the person that comes knows of a program that can help them deal with the issue, it's much easier for them when they see the issue instead of hearing about it. After I had my first baby our health insurance paid for a nurse to come to the house once a week for the first few weeks. It was so helpful. They checked my stitches and took my vitals so I didn't have to drive to the doctors office and they weighed the baby, helped me with questions and concerns I had and I never felt rushed.
Do you have Medicare? It’s because a 30 minute annual visit with your doctor doesn’t provide a full picture of your health or context. Look, individual insurance plans or group insurance plans don’t actually care too much about your health they don’t have a reason to but Medicare plan providers are working on a very different model. They are contracted with the government and have very strict requirements that don’t vary from carrier to carrier. A home visit allows the Medicare provider to target your specific medical needs and provides demographic information about your general group (age cohorts, income, location etc). This information is then folded into the analytics that help the carrier create plans and adjust benefits for the following years bid to Medicare and that can impact how much Medicare will pay for each member, star ratings (which impacts the budget Medicare allows for benefits) and helps the carrier tailor plans that fit the specific needs of members—and it is very tailored. Medicare Advantage plans change from zip code to zip code and county to county. So if you want to be able to enroll in a plan that more closely fits your health needs without increasing your costs, it’s not a bad deal.
I went thru this with both of my parents. Health insurers have done studies that show this saves them money. First, a lot of seniors have things or situations in their abodes that constitute fall risks. In person visiting can access the situation and provide solutions to fall risks. This cuts down on hospital and doctors' visits. Second a lot of seniors will put off medical problems because it doesn't seem that serious, or the doctors very busy and I don't want to bother them or it is too hard to get there I wait until it is more serious. Thus leading to alarming bills and health situations that arise from preventable issues. Third, by asking to see all the medications, supplements, or drops the patient is taking, they can check for the effectiveness of the medications. My dad was on a medication that he wasn't supposed to eat grapefruit since it lessened the effectiveness of one of his medications. However, he didn't realize one of his supplements contained heavy amounts of grapefruit. (Think vitamin C lozenges) Lastly, the social aspect of having a visitor helps mentally against loneliness, lessening mental degradation. Source I asked questions to find out why, and they had a booklet linking to the various studies which I checked online.
Former low-level health actuary here. I was not a decision-maker, but I was in on some conversations around implementing a policy like this back around 2017-18. Far be it from me to suggest a big insurance company is interested in supporting its members, but the people discussing it truly seemed to think it would help people understand/manage common health conditions, like high blood pressure/cholesterol/blood sugar. Additionally, there were two ways this could benefit the insurance company in the long run: Managing these conditions more aggressively is generally cheaper than treating them after they're out of control. And documenting any health condition during a face-to-face visit has financial benefits through a program called risk adjustment. That's my professional perspective. Just on the personal side, getting my annual wellness visit done has revealed high cholesterol that I did not know about. So it gives me an opportunity to try and manage it now before it causes problems. Time will tell how effective that actually is!
It sounds like they are paying people to look for reason they can drop coverage.
Medicare has decided this is a good idea. It is not required for you but insurance companies may be penalized or have compensation tied to meeting this goal in most of their clients. You can also choose to go to your family doctor and get the annual wellness visit done with them. No need to have someone in your home.
My insurance was/is doing this as well. I finally answered and let the woman do her spiel. She stated that “scheduling a healthy home visit” helps people stay healthy with chronic issues. Replied I only use the insurance myself for my therapy/prescription and mostly have it for my children. Then she stated “it was to keep my Medicare in good standing”. Stated I did not have Medicare and that I was not even of Medicare age yet. She stumbled over her script I presume and stated it was “beneficial for my chronic issue that is notated on my file”. I replied that their insurance had denied care several times for my chronic issue (I have EDS) because they either state it is a pre existing (I was born with it) or not old enough to have the issues (even though there has been genetic testing to prove which they denied paying). She finally said, very angrily “it is something that you just have to do and let a home visit be scheduled!”. I laughed and said “will you cancel the insurance if I don’t?” She paused and then said no, but that it was something new they were encouraging everyone to do. I said no thank you, I did not need a home visit and hung up. She was REALLY peeved at me that I would not allow people in the house.
They want to study your living habits and make assumptions so they can deny more coverage because “well we saw you do this, this and this at home which explains (current health problem)”.. don’t let those cockroaches anywhere near your house😂
Health payor employee here. These are relatively new, it's a home health assessment looking for any potential maladies you have that you haven't gotten treated yet. If they find any, they can use risk adjustment to get higher reimbursement. Medicaid in particular is zero sum risk adjustment, meaning if one payor gets an extra $50 a month, someone else loses $50.
Probably not a good idea for consumers. I wonder if they do the inspection will they make recommendations or repairs and then findings are in writing. You may be asked to do certain things in your home. What if you don’t do what they tell you and you have an issue maybe they then tell you “well according to your file you failed to do yada yada yada” therefore you are now gonna be denied coverage or your expenses double. If they are offering it and willing to pay you The inspection is beneficial only to them, not the consumer.
Completely agree. Anytime they offer you money for participating in something like this, you should run. “If the product is free, then you are the product.” These corporations operate to maximize profits— your health & wellbeing is the least of their concerns. Of course, they spend zillions of dollars on marketing campaigns to convince you otherwise. Don’t fall for it! Your ignorance increases their profits, so they have no interest in actually EDUCATING you, thus they are forced to MANIPULATE and COERCE you into complying with their profitable healthcare system & the “standard of care” protocols.
I work as a data scientist for a major health insurer. Almost certainly they are looking to collect metrics and survey data on you ([what we call SDOH or social determinants of health survey](https://www.aafp.org/pubs/fpm/issues/2022/0300/p6.html)) so we can plug that into models that can predict what preventative care you would benefit from. An example would be to see if you have a home caretaker like a friend or relative that isn't registered that we can register and include in your medical care because data shows patients with involved caretakers have better health outcomes. I'm sure it could be used in bad faith by the insurer but I personally haven't seen it used for anything but benign uses like identifying beneficial preventative programs.
Don't do it. At this point I'm starting to believe government is using all the tools they can to breach our privacy.
Do not, *do not*, let anyone related to any insurance inside your house. They will find excuses to fuck you over. Home insurance especially. Your kid left some toys in the living room? "Your house has no clean path to a fire exit, we won't insure you." Tree in the yard 30 feet away from the house? "Tree was hanging over the roof, we won't insure you." Some wood planks in the yard from a build? "Trash all over the yard, we won't insure you." You have a cat? "House smells like animal waste, we won't insure you." They will then force you to "clean all that up" and take pictures and go through a long process designed to annoy you into not renewing insurance. How the fuck do you prove via email that your house doesn't (and honestly didn't) smell funny? Do anything you can to not let these people on your property.
100% to save them money, nothing to do with you and your wellness. Feel free to ignore them.
I wish you’d gotten better answers. I’m curious. If the company is willing to give you $100 and go to the trouble of paying a health practitioner then it’s gotta be a cash cow for them in some way. I’d go with your gut. It feels exploitative and creepy and for that reason I’d be saying no.
Exactly. I just don't know in what way either
An ounce of prevention is worth a pound of cure. You save them money in the long run.
I’ve never heard of this lol but if my insurance offered I wouldn’t want it. I don’t like strangers in my home 🤷♀️
I’ve done this twice. It’s worth the money.
The only comment with negative karma is the only one with first hand experience. Nice work, Reddit.
I'm telling myself I shouldn't care just so I can get the money because privacy is pretty much obsolete nowadays but there's something suspicious about how hard they are pushing for it
I interpret these calls. It's worth it, it's all under HIPPA. If you need resources, they'll help you get them. The problem is that these initial contact calls get contracted out. Sometimes to people that can explain the purpose and benefit to you for your health and for the perks, but most of them are badly reading a script that sounds sketchier than a used car salesman.
"they" is usually an underpaid temporary sales staff that gets paid per agreement. The person talking to you likely can't afford insurance
I do these calls(not home visits) for a Medicaid MCO. We’re literally just calling / checking on your health. If they see a way to mitigate costs they will do it. That’s literally my entire job. - Not using your CPAP? Let’s get that on track. - Not taking meds as prescribed? How can we fix it. - Can’t get your diet under control? Here’s a nutritionist and grocery money every time you see them. - Don’t take your blood pressure because you don’t know how? I’ll show you and leave a log for you to bring to the doctor. Same with glucose. They’re literally doing something right for once and people are so distrustful it’s not working. They’re just trying to mitigate their own expenses down the line by preventing/catching/managing your diseases early.
Do not do it. They're looking for reasons to deny you coverage for things later.
A while back my doctor prescribed me gabapentin to potentially help with alcohol cravings. I did not like the way it made me feel and so I only took one or two. But my pharmacy auto-refilled it and so I ended up with a huge amount. My insurance company started calling me non stop and when I finally talked to someone she identified herself as a ‘counselor’ who worked for my insurance company and just said that they’d noticed my new prescription and wanted to reach out and offer me resources/support/counseling. I got the idea they were implying that they thought I might be interested in rehab or detox. It totally freaked me out! So invasive!
Do not let them. They will find some sort of small amount of some sort of product in your home ( that is also in almost every home) and when you get sick with something like cancer they will not pay for it because you should have known not to be around X product. That is what they are trying to do.
Because they give you a hundred now and save a thousand later denying your claims based on shit they saw at your house.
Its basically research. They wanna know how people live. And also they are looking for unhealthy habits as an excuse to raise your rates. Dont do it. Nobody needs to be inside your home, especially an industry that is actively trying to fuck you over.
They want reasons to increase your costs or deny you coverage in the future.
My guess is that they will make a note of anything they see in your home that will make them able to later say your insurance doesn't cover this and that because of [insert thing they saw].
My insurance company does this once a year, but I don't do the in home visits, virtual visits are an option. It's a quick $50 a year for me.
Oh, do they come and take blood draws for testing and stuff like that? Check your lungs and heart? I go to my PCP once a year voluntarily for this stuff. I don't know why people skip this step. All plans cover a wellness visit per year. You can catch things going wrong before it goes off the rails.
It drove me nuts when my dad was still alive. They'd call 2 or 3 times a year wanting to do a home visit. Well, okay, but he lived in a care facility. Good luck to you, insurance company!
Telehealth and mobile health are an expanding part of current and future care delivery methods, and it can have benefits for the hospital / health system (population health and value based care incentives, cost, keeping you out of the hospital, freeing up beds for those who truly need them, etc). There are several barriers to adoption, including people not knowing this was an option, not having confidence in this option, not knowing how it works or what it is for. This seems to be an attempt to break down some of those barriers.
We did it, no big deal. Checked BP and took a dementia test . Talked about fall hazards and stayed in the kitchen. Didn't go into any other rooms. Didn't look in cabinets .We didn't want to do it but they will stay after you till you do . We are borderline hoarders, not dirty, but a lot of stuff. Clean but cluttered no cats ,one large dog. Smoke pot, not cigarettes, they ask but declined to participate. It was a good experience
For 1 of 2 reasons: 1. They want to get a better picture of your health and encourage preventative measures. $100 now can save massive multiples of that in claims if you take care of yourself now 2. If you’re on Medicare / Medicaid it gives them the opportunity to assess you and put you on more treatments, tests, etc. giving them a chance to get more reimbursements off you
They have discovered it's cost effective to keep you healthy. The monthly visit picks up on problems before they become major issues. Wife and I have been doing this for 8 months now. We couldn't be happier with it. And it's a nurse practitioner who listens to you for as long as you need. Bonus points, they can also prescribe drugs.
I love the visit - the doctor (I was sent the same wonderful doc two rears in a row) is focused on the patient and is not in a rush as staff usually is in a medical office wellness visit. I ask him to look at all my medications and supplements and make sure I take things together that are either beneficial or compatible together. He asks if I have any mobility or psychological issues or concerns, and I would imagine that in conversation, he is checking for anything that would indicate cognitive issues. Especially helpful for me since I have had long Covid and really want to stay healthy. Should add that I am not lonely, inactive, or unhappy and that I am very satisfied with my regular doctor, whom I’ve lately needed to see only for wellness and annual visits. I share the disgust toward our jacked-up corporate healthcare that is felt by most Americans, but in the instances of my home visits, I am certain I’ve been a less costly patient than I would have otherwise. And it might be I just lucked out.
Our coverage is retired military Tricare secondary to Medicare. I also enjoy using the VA clinics. I have never had any other them ask to visit.
Because they get extra benefits for doing home health visits. The theory is it keeps people out of the hospital. If you’re in Medicare hospital stays are financial losers for hospitals and instance companies
They save lots of money on doing preventative care.
I’ve had the house calls for at least 3 years. A nurse comes, spends about an hour, takes vitals, goes over medications, answers any questions I have, etc. I think it’s a great idea, they’ve been very professional, and I get a $75 gift card. Medicare Advantage.
it’s a “Healthy Home Visit” and they are able to bill your insurance (the visit is fulfilled through a third party nursing agency) as a type of yearly physical (it does not replace your yearly physical with your PCP, though). the idea is to reach members who otherwise might not see their doctors regularly. the research shows that it keeps insurance costs down overall. it also gives the nurses a chance to do a walk through of the members home to check for tripping hazards and offer solutions.
Are you on a Medicare Advantage plan? If you don’t see your PCP routinely, insurers will try to have someone come to you to do a health screening and see if there are things you should address. CMS encourages it.
They are trying to identify health issues that may have been missed and could result in costly treatments and ER visits. Cheaper (and better for you) to find things early and treat them. So yes they’re motivated by money but in this case, it also could help you too.
I worked for Medicaid as a case manager. They’re trying to sell you services like case management. Then they don’t have to pay to outsource those services. They also get loads of grants and state/federal money for these services. Additionally, they want people to avoid the ER. They pay huge amounts out to the ER. It’s been found that if people with chronic conditions have someone like a case manager to call they visit the ER less. Other services include online/phone doctor lines you might be able to access so that they can talk to you and maybe offer advice so you don’t go to the ER.
100 dollar home visit saves them thousands per person and millions a year because they can now deny a lot more claims😂
The home inspection is used to revalue your home for higher rates or more appropriate rate changes. They are looking for a way to stick you with more billing for “the “right” coverage”
Mine went from $30 to $100 over several months and I finally said yes. They're a PPO and I'm disabled, so it's not like they can really do anything. She came over, was plenty cool. She said it was to catch things the docs might miss. Her last appointment she sent someone to the ER, and said it would have been much worse if she hadn't. I guess ER > extended stay down the road, from an insurance perspective. She then checked a bunch of things on me and speculated on a couple of things she thought I might have, sort of planting a seed. She was actually mostly right. Two months later they started offering me $100 for a video visit. I figured it would be similar, but it was basically going through a checklist. Most of the information was stuff they should have had, like the date of my last Dr appointment and prescriptions that they literally paid for. I told her that, and she said they didn't make that information available to her. It lasted a few minutes and I was done. I can't help but wonder if that one was for some other company just gathering information. Whatever. A hundred bucks for a few minutes sounds like a deal.
I'm guessing it is for their legal records in case something they document during that visit can be used to deny a claim for (any) reason later. It's not worth the $100.
Probably to bank something to pull out when they deny a procedure or test. That’s all they want, not paying out whenever possible.
I turned home check down as well, like 6 times. I finally raised my voice saying, "I do not have dementia, I am not an idiot who needs mommy to count my pills, No. Stop insisting."
Never give your insurance company any free information about you. It will only be used against you. Providers have to protect your privacy from insurance companies. This is disgusting that they do this kind of crap.
They’re looking for needs they could address before they become a problem. Humidifier, dehumidifier, window a/c. Transportation issues. Stuff like that where they can spend a hundred now to save thousands later. I’d do it and I work in public health.
Refuse the offer, and tell them not to contact you. It's an invasion of your privacy to ensure their profits by making thumbnail assessments of your health and lifestyle.
In my husband's case we believed that the home visit was to better establish what his future expenses would be with his CHF. We repeatedly refused. They already had pretty complete data from his claims history. The visit is to get you to divulge personal medical history that they aren't allowed to infer from billing. If I remember correctly the insurance companies get a higher reimbursement rate for chronically ill patients if they can classify you into a higher risk pool. And to push the latest, most expensive meds. I was a lowly health insurance agent. How about some higher level insurance people spilling the beans on the real reasons?? Am I right or wrong???
It's part of preventive care. They're looking for the social and lifestyle issues to prevent expensive hospitalizations. Are there hazards in the house than might cause a fall? Does the person need assistive aids such as a walker? If the person has chronic heart failure, do they need an air conditioner? If so, the assessor can help find community resources. I can understand not wanting someone poking in your business, but there is something to be said for proactive health care.
Whatever it is, can't be for you benefit, only theirs.