THE BIG RALLY FOR OUR COURT CASE IS FINALLY HERE-THURSDAY MARCH 21st, 2024, SEE BELOW
"Petitioners allege that the City has unlawfully tried to divest Medicare-eligible retirees and their dependents of promised healthcare benefits by attempting to switch the retirees from their existing healthcare plans to an inferior plan, the Aetna Medicaid Advantage Plan."
THIS IS IT!
SHOW UP ON THURSDAY MARCH 21st, 2024
at 41 MADISON AVE
(between 25th & 26th Streets)
SUPREME COURT APPELATE DIVISION
Its across from Madison Sq. Park.
Please arrive no later than 1:30pm
If you are disabled and cannot go up 6-8 steps (wheelchairs/walkers) you will need to enter via 41 Madison Ave. A security guard will need to be called over to screen you and then escort you to our court area. Give yourself time. In furtherance of this goal, this Court has designated Margaret Sowah, Deputy Clerk of the Court, to serve as its ADA liaison, to be contacted, in advance, if possible, when reasonable accommodations on the basis of disability are needed. Ms. Sowah may be contacted by email at AD1ADALiaison@nycourts.gov, or by telephone, at 212-360-4987. An accessible entrance to the courthouse is available at 41 Madison Avenue, 2nd Floor, New York, New York.
Everyone else can enter via 27 Madison Ave for security screening.
We are LAST on the docket. The courtroom opens at 1:45.
Bring a snack as we will be there a while! We want to see thousands of you there!
There are sitting areas where you can have a drink while waiting.
The NYC Retirees
NEW YORK, Feb. 8, 2024 /PRNewswire/ -- Lucid Diagnostics Inc. (Nasdaq: LUCD ) ("Lucid" or the "Company") a commercial-stage, cancer prevention medical diagnostics company, and majority-owned subsidiary of PAVmed Inc. (Nasdaq: PAVM , PAVMZ) ("PAVmed"), today announced that it has contracted with the World Trade Center Health Program ("WTCHP") to provide the EsoGuard® Esophageal DNA test as a covered benefit to the more than 120,000 responders and survivors who participate in the program. The WTCHP provides medical monitoring and treatment to those directly affected by the 9/11 terrorist attacks, including members of the Fire Department of the City of New York (FDNY) and other emergency responders at the World Trade Center, recovery and cleanup workers and those who were in the New York City Disaster Area on September 11, 2001, or in the months that followed. EsoGuard is now reimbursable at $2,475.81 per test prescribed by clinicians at one of WTCHP's Clinical Centers of Excellence.
"We are grateful for the opportunity to provide EsoGuard esophageal precancer testing to those affected by the devastating 9/11 terrorist attacks," said Lishan Aklog, M.D. , Lucid's Chairman and Chief Executive Officer. "As a result of their exposure to dust, smoke, and debris, these heroes are at increased risk of developing cancer, just as firefighters are in general. In fact, nearly 35,000 have already been certified as suffering from gastroesophageal reflux disease (GERD), and therefore are at increased risk of developing esophageal cancer. Lucid remains deeply committed to expanding patient access to EsoGuard testing, with the ultimate goal of preventing esophageal cancer and cancer deaths. We look forward to offering EsoGuard testing to WTCHP participants through dedicated #CheckYourFoodTube Precancer Testing events in the New York metropolitan area. This new program is the product of our ongoing, intensive efforts to drive coverage for EsoGuard testing through direct contracting initiatives."
About Lucid Diagnostics
Lucid Diagnostics Inc. is a commercial-stage medical diagnostics company focused on cancer prevention, and subsidiary of PAVmed Inc. (Nasdaq: PAVM ). Lucid is focused on the millions of patients with gastroesophageal reflux disease (GERD), also known as chronic heartburn, who are at risk of developing esophageal precancer and cancer. Lucid's EsoGuard® Esophageal DNA Test, performed on samples collected in a brief, noninvasive office procedure with its EsoCheck Esophageal Cell Collection Device, is the first and only commercially available diagnostic test capable of serving as a widespread screening tool for at-risk patients to mitigate the risks of cancer and cancer deaths through early detection of esophageal precancer.
For more information, please visit and for more information about its parent company PAVmed, please visit:
WE HAVE BEEN GETTING ALOT OF QUESTIONS ABOUT THE NEW DENTAL PLANS WHICH HAVE BEEN ENACTED SINCE THE FIRST OF THE NEW YEAR.
IF YOU ARE A RETIRED FIREFIGHTER, THE NEW PLAN IS CALLED
"THE MET LIFE PLAN"
IF YOU ARE A RETIRED OFFICER, THE NEW PLAN COMES UNDER "UNITED HEALTHCARE"
EVERYONE SHOULD HAVE RECEIVED ID CARDS. YOUR DENTIST SHOULD BE AWARE OF THE NEW PROGRAMS BUT IF THEY AREN'T SHOW THEM YOUR NEW ID CARD.
IF YOU DID NOT RECEIVE AN ID CARD THEN
CALL THE FOLLOWING NUMBERS:
FOR THE UFA: CALL MARTY TIGHE at (646) 899-6416
FOR THE UFOA: CALL (212) 293-9300
CLICK ON THE FOLLOWING LINK TO TAKE A FREE TEST OFFERED THRU MICHAEL J. FOX .ORG
THIS TEST WILL HELP YOU DETERMINE IF YOU MIGHT BE HAVING SYMPTONS OF PARKINSON'S.
The only Qualifications are that you are 60 and above in age and that you never had Parkinsons. The Test is FREE.
Medicare Advantage provides health coverage to more than half of the nation's seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping some or all contracts with the private plans altogether.
Editor's note: This article was originally published Sept. 27. It was updated Nov. 14 to reflect new contract developments between hospitals and Medicare Advantage plans, which are listed below.
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.
"It's become a game of delay, deny and not pay,'' Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker's. "Providers are going to have to get out of full-risk capitation because it just doesn't work — we're the bottom of the food chain, and the food chain is not being fed."
In late September, Scripps began notifying patients that it is terminating Medicare Advantage contracts for its integrated medical groups, a move that will affect more than 30,000 seniors in the region. The medical groups, Scripps Clinic and Scripps Coastal, employ more than 1,000 physicians, including advanced practitioners.
Mr. Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene's Health Net and a few more smaller carriers. The system will remain in network for about 13,000 MA enrollees who receive care through Scripps' individual physician associations.
"If other organizations are experiencing what we are, it's going to be a short period of time before they start floundering or they get out of Medicare Advantage," he said. "I think we will see this trend continue and accelerate unless something changes."
Bend, Ore.-based St. Charles Health System took it a step further and was not only considering dropping all Medicare Advantage plans, but also encouraged its older patients not to enroll in the private plans during the upcoming enrollment period in October. The health system's president and CEO, CFO and chief clinical officer cited high rates of denials, longer hospital stays and overall administrative burden for clinicians. Ultimately, the health system has decided to remain in network with four MA carriers and will not renew contracts with three.
"We recognize changing insurance options may create a temporary burden for Central Oregonians who are currently on a Medicare Advantage plan, but we ultimately believe it is the right move for patients and for our health system to be sustainable into the future to encourage patients to move away from Medicare Advantage plans as they currently exist," St. Charles Health CFO Matt Swafford said.
"I feel terrible for the patients in this situation; it's the last thing we wanted to do, but it's just not sustainable with these kinds of losses," Mr. Van Gorder added. "Patients need to be aware of how this system works. Traditional Medicare is not an issue. With these other models, seniors need to be wary and savvy buyers."
Here are 13 more recent instances of hospitals dropping Medicare Advantage contracts:
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.
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.
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.
Her Team needs donations to continue the barrage of Lawsuits she is bringing against the city. She's "ALL IN" for all of us, so step up and help even if its only 25 bucks,
GET IT UP!
Click on the Link below.
We are Retired NYC Firefighters of all ranks. We meet five times per year at two locations; 901 Lakeville Road in New Hyde Park and 3051 Nostrand Ave in Brooklyn, NY. Through our Newsletter and this website we hope to keep you informed about your pensions.
Are you passionate about what we're doing? Let us know! We are always looking for volunteers to help us make our organization better for our members. We'll help you find a way to volunteer that best suits you. We're excited to have you join the team!
Whether you help through monetary donations, volunteering your time, or spreading our mission through word-of-mouth, thank you. We couldn't accomplish our goals without the help
of supporters like you.
RETIRED MEMBER'S ASSOCIATION, INC
Fire Department, City of New York
ORGANIZED JANUARY 1ST, 1946
APPLICATION FOR MEMBERSHIP
We offer two types of Membership.
Life Membership- one time payment of $250.00 gives you a gold RMA Membership Card and our periodic newsletters.
Annual Membership-Annual dues of $25.00 gives you 1 year of membership with associated Card, and one year of issued Newsletters.
Once you have decided on
the type of Membership you desire,
download the PDF Application above,
fill out and send with your check
made payable to the RMA
and send via US Mail to:
PO Box 1332
Baldwin, NY 11510
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(see Lapel Pin above-right)
Both Life and Annual Members will receive Critical Instant Updates as
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