MARIANNE PIZZITOLA LEADS THE CITY HALL RALLY

250-300 SHOWED UP for the Rally & March from CITY HALL to the CVS at the corner of Spring Street & 6th Ave. Unbeknownst to me or anyone in the crowd, we all learned that CVS owns AETNA. Backed by some Unions, AETNA would be our Healthcare Advocates in the Medicare Dis-Advantage Plan. So we protested in front of their store at the

corner of Spring Street & 6th Ave.

It was a good turn out and very loud. We were escorted by the

NYPD from City Hall to CVS.

Marianne Pizzitola led the charge. At City Hall she spoke with members

of the City Council.

They all know her on a first name basis.

Many Thanks to Tom Hogan & Wife, Mike O'Keeffe, Joe Bryant and Bill Schillinger for showing up to lend their support.

See the pictures below of the day.

[PLEASE SCROLL DOWN BELOW TO SEND A MESSAGE TO MAYOR ADAMS]

LATEST VIDEO FROM MARIANNE EXPLAINING THE AETNA DEBACLE PLAN:

https://www.youtube.com/watch?v=EN-Dkyna0wQ

IF WE ARE FORCED INTO THIS PLAN WE ALL GET SCREWED

THIS MAYOR DOESN'T GIVE A CRAP ABOUT US

PLEASE SEND HIM A MESSAGE SCROLL DOWN BELOW

or go to the ACT NOW PAGE

UPDATES TO THE MEDICARE DIS-ADVANTAGE PROPOSAL

A CO-PAY WIN FOR THE CITY

Because the City revised the Emblem contract, the Judge lifted the stay on the copays. This means that beginning January 2025, we will most likely see copays. There is no ending date to the contract, it expires when the City goes to change it. This is another gift of the MLC under the leadership of DC37 and the UFT, and its chair Harry Nespoli. Copays in this contract are $15. We will keep you posted when more information comes out of OLR on these changes. But please be patient, as the meat and potatoes of the case has not yet been argued. This is just the stay that has been lifted... and the City has not put out anything on this yet, but since open enrollment is around the corner - we will be watching.

UPCOMING EVENTS / RALLYS

A CO-PAY WIN FOR THE CITY

GO TO OUR ACT NOW PAGE FOR FURTHER

INFO

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A CO-PAY WIN FOR THE CITY

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Donations are still needed as we are juggling three and possibly FOUR oral arguments! Thank you for your generosity! See below to donate! There are 250,000 retirees who are on Medicare. There are more who will be on Medicare soon. If you want to make sure you are not on managed care - forced into a plan your doctors and hospitals do not accept, subjecting you to prior authorization, support our organization. If you never donated, the time is now. For three years, we have proven our strategies and arguments are on point. We have saved retirees thousands of dollars! Not to mention protecting the benefits the City was illegally trying to take away.

Join The NYC Org. of Public Svce Retirees!

MULGREW PULLS THE PLUG ON THE MAP

WILL THEY ALL FALL BY THE WAYSIDE? IS THE END NEAR?...

Sunday June 23rd, the United Federation of Teachers (UFT) announced to their members, retirees and the Press that he was withdrawing his support for Medicare Advantage. He being Michael Mulgrew, President of the UFT, hmm but for how much longer will he preside at this top post? The Clock is Ticking. The Mayor has until this Friday to be recognized by the Court and then to submit an appeal... WE JUST RECEIVED UPDATED INFORMATION FROM MARIANNE: (UPDATED 6/30/24)

"The Mayor did in fact file to appeal his 9th loss on Thursday night. The appeal asks the court for permission to appeal the case. The Court has a few months to decide if they will and then it will be months before it would be heard if it is accepted. We will update you as we get more information."

See Below for Related Articles

CLICK HERE FOR AN ARTICLE IN THE

NY POST

RETIRED TEACHERS SEEK UNION SHAKEUP TO DODGE MEDICARE ADVANTAGE

READ A STORY ABOUT HOW UPSTATE RETIREES FOUGHT PRIVATIZED HEALTH CARE AND WON!

CONTRIBUTE TO NYC ORG OF PUBLIC SERVICE RETIREES

PRESS RELEASE FROM NYC RETIREES:

New York Appellate Division Affirms City Retirees’ Right to Promised Medicare Benefits

Today’s Ruling Bars City From Forcing Retirees off of Traditional Medicare

NEW YORK, May 21, 2024 — Today, the New York Appellate Division issued a unanimous decision holding that the City of New York cannot force its roughly 250,000 elderly and disabled retired municipal workers off of their longstanding Medicare insurance and onto an inferior type of insurance called “Medicare Advantage.” Unlike Medicare—a public program that has protected City retirees for the past 57 years—the City’s proposed new Medicare Advantage plan was a private, for-profit endeavor that would have limited retirees’ access to medical providers, prevented retirees from receiving care prescribed by their doctors, and exposed retirees to increased healthcare costs.

The Court confirmed what retirees have been arguing for months: that they are entitled to the healthcare they were promised for over 50 years. The Court wrote: “The City has made clear, consistent, unambiguous representations – oral and written – over the course of more than 50 years, that New York City municipal worker-retirees would have the option of receiving health care in the form of traditional Medicare with a City-paid supplemental plan. Consequently, the City cannot now mandate the proposed change eliminating that choice.”

Jake Gardener, a partner at Walden Macht & Haran LLP, counsel to the retirees, says, “We are grateful to the Court for recognizing the healthcare rights of retired City workers. Because of the Court’s thoughtful, well-reasoned decision, hundreds of thousands of senior citizens and disabled first responders will be able to receive the medical care they desperately need.”

Marianne Pizzitola, President of the New York City Organization of Public Service Retirees, one of the lead plaintiffs, states, “Retired City workers dedicated, and in many cases risked, their lives for the City for relatively low pay. In return, they were promised certain basic healthcare benefits when they retired. The City’s attempt to break that 57-year promise is shameful and, as the Court ruled today, unlawful.”

Steve Cohen, a partner at Pollock Cohen LLP, also counsel to the retirees, says, “The City owes these retirees a debt of gratitude for their service. Instead, it has been trying to deny them the healthcare they were always promised. Fortunately, retirees fought back and they won.”

[LET'S HOPE THE CITY WILL NOT BE GRANTED AN APPEAL-

CHECK BACK SOON TO SEE WHAT HAPPENS]

Join Us

HERE WE GO AGAIN-CITY TO APPEAL APPELATE COURT DECISION:

READ THE FOLLOWING ARTICLE FROM THE CHIEF:

Appeals panel rebuffs city’s Medicare effort

Municipal retirees notch another court victory, but Adams administration will appeal

Retired New York City municipal workers have scored yet another court victory in their ongoing efforts to prevent the city from switching them to a cost-saving private plan and stripping their Medigap coverage. RICHARD KHAVKINE/THE CHIEF Posted Tuesday, May 21, 2024 4:34 pm BY RICHARD KHAVKINE City retirees secured yet another court victory in their bid to keep their traditional Medicare and no-cost supplemental coverage. In a unanimous decision issued Tuesday, a State Supreme Court Appellate Division panel upheld a trial court finding that switching the retired municipal workers to a cost-saving private plan and stripping them of their Medigap coverage would break long-ago guarantees city officials made to employees. “The City has made clear, consistent, unambiguous representations oral and written over the course of more than 50 years, that New York City municipal worker-retirees would have the option of receiving health care in the form of traditional Medicare with a City-paid supplemental plan. Consequently, the City cannot now mandate the proposed change eliminating that choice,” the four-justice panel of the Appellate Division’s First Department concluded. The panel’s conclusion, upholding Manhattan Supreme Court Justice Lyle Frank’s August 2023 finding, marked the fourth time that courts have sided with the retirees. The city said it would appeal the ruling. Marianne Pizzitola, the president of the New York City Organization of Public Service Retirees, one of the lead plaintiffs in the case, lauded the decision, but called the city’s attempts to switch the retirees to a private, for-profit benefits plan “shameful and, as the Court ruled today, unlawful.” “Retired City workers dedicated, and in many cases risked, their lives for the City for relatively low pay. In return, they were promised certain basic healthcare benefits when they retired,” Pizzitola said in a statement.
The retirees’ lawyer, Jake Gardener, said he and his team were grateful for the court’s decision, which he said recognized the health-care rights of the former city workers. “Because of the court's thoughtful, well-reasoned decision, hundreds of thousands of senior citizens and disabled first responders will be able to continue receiving the medical care they desperately need and to which they are entitled,” Gardener, a partner at Walden Macht & Haran LLP and a former FDNY firefighter, said by phone. Adams administration officials have argued that shifting the retirees to a privately run plan would save the city as much as $600 million annually, with the savings derived from federal subsidies available to Medicare Advantage plans. In turn, the subsidies would help replenish the city’s Health Stabilization Fund, which supplements employee welfare funds. The city intends to pursue the matter to the state’s highest court. “The city will seek the Court of Appeal’s review of today’s ruling,” the director of public affairs for the city’s Law Department, Nicholas Paolucci, said in a statement. “The city's plan, which was negotiated closely with and supported by the Municipal Labor Committee, would improve upon retirees’ current plans and save $600 million annually. This is particularly important at a time when we are already facing significant fiscal and economic challenges." A representative for the Municipal Labor Committee, the umbrella organization of city public-sector unions, which supports the switch to a Medicare Advantage, said the heads of the various unions would be meeting with attorneys to discuss the decision. ‘Significant evidentiary support’ The decision, written by Associate Justice Ellen Gesmer, underscored “the hundreds of affidavits,” including from former city officials and medical professionals, along with thousands of pages of documentary evidence, in support of the retirees. It highlighted an affidavit by Lilliam Barrios-Paoli, herself a retired longtime city official who headed several departments, including that charged with personnel. Barrios-Paoli wrote that for decades the city’s human resources administrators had promised that retirees would have a choice of health plans and came to rely on those assurances. “The guarantee of good healthcare in retirement including the choice to participate in traditional Medicare with a City-paid supplemental plan was an essential recruiting and retention tool,” Barrios-Paoli, in a passage cited in the decision, said in her affidavit. Resuming a theme that emerged during the panel’s March 21 hearing on the matter, the decision noted that although city officials disputed claims from the retirees and health care experts, they “did not present any evidence controverting them,” and instead relied “heavily” on summary health-benefit program descriptions. “Notably, respondents submitted not a single affidavit by any City official disputing Ms. Barrios-Paoli’s statements, thus effectively conceding them,” Gesmer wrote. The justices also found that the city’s assertion, purportedly contained in a summary program description from 1989 but not included in the court record, that it reserved the right to change or even terminate benefits or health care plans was “insufficient to demonstrate that the promise was either qualified or too indefinite, as the reservation of rights was not included in any other SPD.” The panel also highlighted the retirees’ claims, in “unrebutted affidavits,” that they pursued public employment at least in part because of promises of health care, even though they could have earned more money in the private sector. “The particular manner in which the parties chose to litigate this action before [the] Supreme Court resulted in a record with significant evidentiary support for petitioners’ position and very little support for respondents’ position,” Gesmer wrote.

ACT NOW

Hospitals, doctors drop private Medicare plans over payment disputes (Denials Are Happening Now!):

COULD THIS HAPPEN TO US? LET'S NOT FIND OUT, SUPPORT MARIANNE!

One large health system with hospitals in Virginia and Ohio this year cut off in-network access to consumers enrolled in some Anthem Blue Cross Blue Shield Medicare and Medicaid health insurance plans.

Two doctors groups with Scripps Health in San Diego are terminating contracts with private Medicare plans over concerns about payments and routine denials.

For years, hospitals, doctors and health insurance companies have squared off over how much to pay for medical services. Insurers negotiate contracts with hospitals and doctors so their customers can get lower, in-network rates at those facilities. These negotiations, usually hammered out behind the scenes, are becoming increasingly tense and public as hospitals seek adequate payments and health insurance companies attempt to check spiraling medical bills.

Experts say these disputes could be an early warning sign of more contract terminations ahead as hospitals and large doctor groups seek lucrative payments to offset inflation, healthcare workers' double-digit raises and escalating prices for medical supplies.

But for patients caught in the middle of these disputes, the results can be devastating. Some need to switch doctors or insurance plans or potentially pay higher, out-of-network rates at a time when half of Americans are struggling to afford the rising cost of medical care.

Scripps Health ended the 2024 Medicare Advantage plan contracts with two medical units, called Scripps Clinic and Scripps Coastal. The decision will affect about 32,000 patients who will either need to switch Medicare plans or find new doctors.

“We’re unfortunately on the vanguard of what I think is going to be a very ugly few years between hospitals and commercial insurance companies,” said Chris Van Gorder, President and CEO, Scripps Health.

Hospitals target private Medicare plans

Many contract terminations involve hospitals rejecting terms for private Medicare insurance plans, known as Medicare Advantage plans. While traditional, government-run Medicare allows enrollees to choose from a wide variety of doctors and hospitals, private Medicare plans restrict access through networks and impose some cost-sharing requirements such as copayments or deductibles.

Hospitals that are rejecting private Medicare plans say they don’t reimburse at the same levels as traditional Medicare, delay or deny care through prior authorizations or impose other limitations.

Van Gorder said Scripps' Medicare Advantage exit was a “very difficult decision” but one he had to make due to more than $75 million in annual losses. He tried to negotiate more lucrative reimbursement rates, but those talks fizzled.

While private Medicare plans are funded by government-run Medicare, they're also profitable because insurers keep a portion of those payments before paying for care, he said.

Van Gorder described private Medicare offerings as “delay, deny or don’t pay” plans. "They're in the business of making money," he said.

Hospitals cut off insurers that 'don't reimburse us adequately'

Doctors groups and hospitals are more willing to air frustrations over private Medicare plans after think tanks and government watchdog agencies have issued critical reports about these insurers' profits and practices, said David Lipschutz, associate director and senior policy attorney for the Center for Medicare Advocacy.

In 2022, a government watchdog report said private Medicare plans routinely rejected claims that should have been paid and denied services found to be medically necessary. These private plans rejected nearly one in five claims allowed under Medicare coverage rules and denied 13% of authorizations for medical services that government-run Medicare would have allowed, the U.S. Department of Health and Human Services inspector general investigators found.

Doctors and hospitals "are more willing to publicly express their frustration," Lipschutz said, because these private Medicare plans get what "many people would characterize as overpayments."

More than a half dozen other hospital systems from Bend, Oregon to Nashville, Tennessee have announced private Medicare contract terminations or lapses.

St. Charles Health System in Bend said it will end Medicare contracts next year with Humana, HealthNet and WellCare.

Mark Hallett, St. Charles' chief clinical officer, said sticking with those private Medicare plans would "result in restrictions to patient care, longer hospital stays and administrative burdens" for doctors.

>For the whole article click here<

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RETIREE RIBBON

The RETIRED small ribbon can be sewn on above your Left Shoulder FDNY Patch.

Each small RETIRED Ribbon

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They will only be sold at the Meetings. Please see Bill Schillinger at the Presentation Table at the Front of the Room at each meeting. See picture below for what they look like individually.

SMALL RETIRED RIBBONS

See to your left The RETIRED RIBBON.

They will be sold at meetings for $5.00 each.

Our Next Meeting is in Brooklyn on 11/26/24.

SEE YOU THERE...

Next Meeting: 11/26/24-BKLYN

SOCIAL SECURITY ANNOUNCES COLA FOR 2025

MARIANNE PIZZITOLA LEADS THE CITY HALL RALLY

PICTURES FROM THE RALLY @ CITY HALL & THE MARCH TO CVS

America’s Seniors are gonna get screwed for Wall Street’s growing disenchantment with MAP

https://hc4us.org/americas-seniors-are-about-to-pay-a-high-price-for-wall-streets-growing-disenchantment-with-medicare-advantage-health-care-un-covered/

UPDATES TO THE MEDICARE DIS-ADVANTAGE PROPOSAL

A CO-PAY WIN FOR THE CITY

A CO-PAY WIN FOR THE CITY

A CO-PAY WIN FOR THE CITY

UPCOMING EVENTS / RALLYS

A CO-PAY WIN FOR THE CITY

A CO-PAY WIN FOR THE CITY

DONATIONS NEEDED!

A CO-PAY WIN FOR THE CITY

DONATIONS NEEDED!

MULGREW PULLS THE PLUG ON THE MAP

WILL THEY ALL FALL BY THE WAYSIDE? IS THE END NEAR?...

"The Mayor did in fact file to appeal his 9th loss on Thursday night. The appeal asks the court for permission to appeal the case. The Court has a few months to decide if they will and then it will be months before it would be heard if it is accepted. We will update you as we get more information."

See Below for Related Articles

PRESS RELEASE FROM NYC RETIREES:

HERE WE GO AGAIN-CITY TO APPEAL APPELATE COURT DECISION:

Appeals panel rebuffs city’s Medicare effort

Municipal retirees notch another court victory, but Adams administration will appeal

Hospitals, doctors drop private Medicare plans over payment disputes (Denials Are Happening Now!):

Hospitals target private Medicare plans

Hospitals cut off insurers that 'don't reimburse us adequately'

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Who We Are

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Download The 2024/25 RMA Application:

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