Category: Corporations

What’s wrong with “Medicare Advantage” plans?

At this time of year, ads hawking “Medicare Advantage” plans flood every possible media outlet, imploring seniors to call 1-800 numbers and contact their local insurance brokers for “free Medicare evaluations” where brokers can sign them up for Medicare Advantage (MA) plans, also called Part C plans, that offer premiums a bit lower than traditional Medicare and freebies like vision screenings, dental cleanings, gym memberships and a monthly allowance to spend on drugstore merchandise.
These plans definitely sound alluring, but don’t be fooled.
What seems like a good deal up front will likely be far more expensive in the long run because “Medicare Advantage” plans are not real Medicare plans. They are private insurance sold by for-profit insurance companies and they push subscribers into dealing with big bureaucracies that decide which doctors you can and can’t see, what care you can or can’t get, and that can deny you care for vague reasons if it isn’t in the companies’ best financial interests to pay for it.
In the words of my former colleague Wendell Potter, former Vice President of Corporate Communications for Cigna Health Insurance, who became an insurance whistleblower, “Medicare Advantage” plans are neither Medicare nor an advantage. They’re a scam to keep people locked in the private, for-profit health insurance market where companies can continue to exploit them for years, even decades, to generate profits.
What’s so bad about Medicare Advantage plans?

“Medicare Advantage” (MA) plans were introduced 25 years ago on the theory that competition in the private insurance market would result in better insurance and more efficiently-run plans. MA plans are funded by the government, which pays private insurers a set amount for every person they enroll. The amount varies based on how healthy subscribers are, and the government pays higher rates to private insurers for the sicker subscribers.
Insurers must spend 85% of the money they get from the government on patient care. The other 15% is pure profit, so insurers have a built-in incentive to deny coverage to preserve their profits. Enticing seniors into purchasing MA plans early by offering them lower premiums and freebies while they are younger and relatively healthy, generates more profits for insurers in the long run. But as MA subscribers age and need more medical care, they increasingly face getting denied by their insurer for treatments and procedures they may need. This can force MA subscribers to have to go without care, or pay out of pocket for more of their own medical care.
What you need to know:
“Medicare Advantage” plans are private insurance plans that use the name “Medicare” to generate trust among seniors. They are NOT real Medicare plans. If you buy a “Medicare Advantage” plan, you are paying a private insurer to become a gatekeeper between you and your medical care.

1-800 phone number television ad touting “free Medicare benefits review” to recruit Medicare Advantage subscribers
MA plans restrict subscribers to closed networks of doctors and hospitals, called Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). These networks typically are limited and restricted to local areas, and can potentially block subscribers from getting the best care for a given condition. For example, if you are diagnosed with a rare form of cancer that can only be treated at a specialized national medical center like Mayo Clinic, Memorial Sloan Kettering in New York, or MD Anderson Cancer Center in Texas, but this medical center isn’t in your network, your “Advantage” plan can refuse to pay for the care you need. If you have an accident or get sick while outside of the state, and seek care at an urgent care clinic or an emergency room nearby, you could get stuck with thousands of dollars in medical bills because the doctor and medical facility you used were outside your network and your MA plan won’t cover it. MA plans also require doctors get pre-approvals from insurers for many tests and treatments, and get pre-authorization for surgeries and procedures, so if you come down with a fast-moving illness that requires quick medical care, getting pre-approvals and pre-authorizations will needlessly delay your care and cost you precious time that could make a big difference in your medical outcome. Under MA plans, you usually need a referral to see a specialist. MA plans can also put people in the desperate position of having to battle an insurance company while they are sick or injured, to get the care they need.
Contrast this with original or “traditional” Medicare plans, which do not operate off a profit motive. Original Medicare is a government program. The only mandate original Medicare has ever had is to “help the nation’s elderly meet their hospital, medical, and other healthcare costs.”(pdf) Traditional Medicare subscribers can go to any doctor and any facility in the country that accepts Medicare assignment (payment). In most cases, you don’t need a referral to see a specialist. No pre-authorization or pre-approval is required for tests, treatments or procedures you need. Original Medicare has less hassles and headaches and pays it’s portion of the Medicare-approved costs for your care easily, and whenever and wherever you need care. After you pay the annual deductible for the year, which is in the $250 range, there are no further deductibles, copays or coinsurance to worry about.
Fraudulent billing and overcharging are pervasive
Another big problem with “Medicare Advantage” plans is that the corporate insurers that provide these plans have often engaged in fraudulent billing as a way to bilk the government out of more money.
Audits reveal Medicare Advantage plans typically overcharge the government by millions of dollars, at a rate of more than $1,000 per patient per year, on average. Often companies add fraudulent billing codes for conditions patients don’t actually have, like chronic obstructive pulmonary disease (COPD), diabetes or cardiovascular disease, to make subscribers appear sicker to the government so they can collect more money while not actually providing services. The costs to American taxpayers of this fraudulent billing have skyrocketed over the past decade as more seniors are coerced into signing up for “Medicare Advantage” plans. This fraudulent added expense is also hastening the demise of Medicare overall, since costs of the program have increased greatly due to these private insurers’ malfeasance.
In October, 2022, the New York Times reported that 9 of the 10 biggest Medicare Advantage plan providers in the country have been accused of billing fraud. The federal government has sued four of the five biggest players in the national health insurance market — UnitedHealth, Humana, Elevance (formerly Anthem) and Kaiser — for fraudulently over-diagnosing subscribers so they can fraudulently charge the government more money.
So what should you do?

Local TV ad seeks to get people who already have original Medicare to switch to a privately-owned Medicare Advantage plan, to the detriment of the subscriber
A 2021 survey found over half of people in America are confused by health insurance, so if you’re confused, you’re not alone.
Private insurers like customers who are confused or clueless, because it’s easier to manipulate a confused person into buying a plan that will benefit their company’s bottom line, but likely be detrimental to the subscriber in the long run.
Medicare Advantage plans are fraught with problems like denials of care, fraudulent billing, difficulty in getting pre-approvals and pre-authorizations for tests, treatments and procedures, copays and coinsurance. Medicare Advantage plans have been raking in record profits for private insurers while undermining original Medicare by unnecessarily raising program costs through rampant fraudulent billing. At the same time, private insurers are putting the most vulnerable subscribers at risk by denying them care and subjecting them to bureaucratic obstacles to try to keep them from getting necessary treatments and procedures, especially if they are expensive.
So when you sign up for Medicare, don’t be fooled.
Be sure to sign up for traditional, government-operated Medicare, which pays 80% of medical costs. Get a supplemental plan to cover the 20% the government doesn’t pay, and get a Plan D drug coverage plan. At all costs, DO NOT sign up for a “Plan C” or a “Medicare Advantage” plan. If you’re already on a Medicare Advantage plan and want to get out of it, you can switch to original Medicare during the open enrollment period that runs from October 15 to December 7 of each year. After you sign up, your original Medicare plan will take effect on January 1 of the coming year. See an insurance broker to make this change, but beware that brokers may still try to persuade you to keep a Medicare Advantage plan instead of original Medicare, because brokers often get paid higher commissioners for recruiting people into MA plans, or for keeping them in such plans.
Forgo the lure of the slightly lower premiums and freebies up front in favor of signing up for a traditional Medicare plan. Traditional Medicare puts beneficiaries’ best interests — and not profits — first. It will give you better, simpler coverage that will be easier to understand, that will be more reliable and that will make your medical care more affordable and less of a hassle in the long run.
If you have the time and want more information on why MA plans are bad, I suggest watching this 12 minute video (below) by a doctor that explains the problems with “Medicare Advantage” plans, and why people are better off avoiding them:
It’s well worth the time to watch it before you choose a plan. The doctor in the video talks fast and packs in a lot of information, but I guarantee you will understand everything he has written on the white board by the time he’s done.

Former Red Rock principals who left under a cloud open financial consulting business, go into real estate locally

Note that “Bookcliffs Investment Group, LLC” is not be confused with “Bookcliffs Financial Planning and Investments,” which is an entirely different company unaffiliated with Reade and Adams’ business.

Former Red Rock Nissan and Kia managing partner Brantley Reade and the former General Manager of Red Rock’s GMC dealership, Cord Adams, who both left Red Rock under a cloud on the same day last January, opened a financial investment business together last February, shortly after leaving Red Rock.

Reade and Adams were part of the so-called “fraternity” of managers from Tim Dahle dealerships in Salt Lake who came to Grand Junction to help run the Red Rock Auto Group. They were high-management casualties of the large-scale personnel churn that began near the end of 2022, after customers started revealing the illegal and unethical business practices they fell victim to while buying vehicles at Red Rock dealerships.

Second Red Rock Auto financial manager charged with crimes against customers

Daily Sentinel headline, August 29

A second former Red Rock GMC financial manager has been charged with forgery, criminal impersonation and identity theft within the last month after posing as a customer on a phone call to the Canvas Credit Union to try to expedite a customer’s vehicle loan.

Matthew Morris acted as an accomplice to Tiffany Miller, the first Red Rock GMC financial manager charged with the same crimes in early August. Both Morris and Miller were fired from Red Rock, but in her arrest affidavit Miller pointed to Red Rock management as pressuring her to commit the crimes. In the same affidavit (pdf), Morris said that Red Rock GMC Sales Manager Tyson Chambers and General Manager Caleb Stillman both knew he and Miller were making the fake calls to

Tyson Chambers, General Manager of Red Rock GMC

the lender and that they “and essentially encouraged the behavior.” Morris added that “he was terminated [from his job] not for making the call, but for being caught.”

Red Rock promotes its reviews on TV, but wait…

Screen shot of a Red Rock TV ad

The Red Rock Auto Group, which owns five dealerships in Grand Junction, has been advertising heavily on local news with ads that tout what they say are their many positive reviews.

We’ve already seen evidence, however, that indicates  Red Rock manipulates online reviews by coercing its employees to write positive reviews (a violation Google policy) and by purchasing good reviews from customers by offering them perks like free gas and oil changes in exchange for positive online reviews.

But we shouldn’t forget the slew of gritty and honest negative reviews that show the real difficulty Red Rock has caused so many customers, and the responses or lack thereof to such reviews from “the owner.”

Red Rock Auto Group’s greedwashing campaign

Red Rock got this free media from the Daily Sentinel on January 19, 2023, with this photo of their donation to Court Appointed Special Advocates (CASA). Red Rock also got Joy Thompson of CASA to say “We love Red Rock” on a January 19, 2023 local KREX-TV news segment about the donation.

After a company has been outed as over-the-top greedy, there’s nothing left for it to do but make conspicuous donations to local charities to score public relations points and blow smoke to make people forget about how their business has harmed the community in the long term.

That’s likely why, near the end of 2022, after all the unseemly tactics Red Rock Auto dealerships had been using on customers to fleece them out of thousands of dollars over the last 7 years were exposed, Red Rock suddenly started ramping up its donations to local charities and promoting their donations in ads on TV and through free media given to them by local TV stations and newspapers.

A company that ingratiates itself to reputable charitable causes as a way to distract from its immoral acts is engaging in a form of “greedwashing,” a term developed during the taxpayer-funded federal bailouts of the big banks during the economic crash of 2008-2009:

Criminal investigator who was investigating Red Rock quits & goes to work for Red Rock

Dale Sundeen (Photo: Auto News)

Dale Sundeen, the Colorado Department of Revenue Auto Industry Division’s criminal investigator who was investigating Grand Junction’s Red Rock dealerships, quit his job with the state and went to work for Red Rock Auto Group as their “Corporate Director of Compliance.”

KREX-TV broadcasts 5 minute news segment about Red Rock forgeries

KREX-TV last night ran a 5 minute news segment about Red Rock dealerships, which are currently under investigation by the state for problems including forgeries of customers’ signatures on legal/financial documents like contracts, Powers of Attorney, title and loan documents, and the addition of thousands of dollars worth of extras to customers’ contracts without their knowing, like extended warranties and special coatings.

Below is the full statement of a former title clerk who worked at Red Rock. This person asked to remain anonymous. This statement was included in the KREX news segment, but it merits fuller attention because of its gravity. This person’s employment at the dealership has been verified, and they had experience with the Mesa County Department of Motor Vehicles before going to work for Red Rock:

Red Rock starts getting the message, unwinds deal for strapped couple & gives out personal cell phone numbers of local partners for people to call if they’ve been wronged

Red Rock Nissan at 2582 Highway 6 & 50 in Grand Junction

The Red Rock Auto Group seems to be starting to get the message about the financial hardship they’ve been causing people by defrauding customers and carrying out business in bad faith.

This week Red Rock Nissan went out of their way to help “the Andersons” (not their real name), a struggling young couple with three kids, two of whom are special needs kids, who were recently featured in this blog as an example of the kind of bad deals people were unknowingly getting into at these dealerships.

Another former Red Rock employee gives more information about how the dealerships defrauded customers, banks, lenders

Red Rock Nissan at 2582 Highway 6 & 50 in Grand Junction

Note: I am re-posting this article from last December, now that a second former Red Rock dealership financial manager, Matthew Morris, has been charged with criminal impersonation, forgery and identity theft. This article contains information from a former Red Rock financial manager about how Red Rock allegedly (and routinely) defrauded customers as well as lenders (banks and credit unions). The article got little notice at the time I posted it, but it’s even more relevant now that criminal charges have been brought against a second Red Rock employee, who has implicated upper management in these activities..

Yet another former employee of a Red Rock auto dealership has contacted AnneLandmanBlog wanting to unload about what they experienced while working for Red Rock, and wanting others to know how business is done at these dealerships. This person has more detailed knowledge about financing of vehicle deals. Their name is withheld at their request. I asked this person follow-up questions based on information provided by a previous Red Rock employee who came forward and told about the illegal acts allegedly taking place at the dealerships, like falsifying customers’ financial information to lenders, misuse of digital signatures, forging of signatures, and more. This new person has even more detailed insight into these dealerships, the things they do to customers and banks, and how and why Red Rock dealerships operate so differently from other dealerships  in town and around the country.

Local family unknowingly gets into deep financial trouble after patronizing Red Rock Nissan

Lyn M. says this screen shot “is all we know about the loan” she and her husband got from Red Rock Nissan in Grand Junction. They went to Red Rock to buy a car advertised on the dealership’s website at $17,000. Without knowing it, they came out with a loan for $30,000 at an interest rate of 12.49%, far above what they could afford.

Lyn Anderson and her husband Jim (not their real names) thought they should trade in their older Ford pickup and get a slightly newer, more family-friendly vehicle, so they went online to see what was available locally.

Little did they know what they were getting themselves into.

Another Red Rock dealership victim

Red Rock GMC contract with unauthorized $4,995 charge for “Portfolio” (an extended warranty the customer wasn’t made aware of), “Worry Free Maintenance” that the customer was told would give him three “free oil changes,” and a $2,500 charge for “Resistall” coating, a treatment that ruined the glass on his truck. Red Rock dealerships are affiliated with the Tim Dahle Auto Group dealerships out of Utah.

Last spring, Daniel Macias (not his real name) went to the Red Rock GMC dealership on First Street to buy a used Chevy Silverado pickup truck. Like other Grand Junction Red Rock dealership patrons, he was unaware of the trap he was walking into.

Trump campaign threatens KREX

KREX received a cease-and-desist letter (pdf) from President Donald Trump’s re-election campaign threatening the station over a political ad it ran called “Exponential Threat” produced by Priorities USA, a Democratic super PAC.

The ad juxtaposes a montage of the many dismissive comments Trump made about the Coronavirus pandemic earlier this year with an animated chart showing the rising number of infections in the United States. It ends by saying: “America needs a leader we can trust.”

The Trump campaign sent the threatening letter to television stations across the country, suggesting it would sue the stations for defamation and urge the Federal Communications Commission to revoke their FCC licenses.

Citizens protest Pendley at new BLM office in G.J.

Protest Jan. 2 at BLM’s new offices on Horizon Drive.

About 35 people turned out in 27 degree weather to protest a visit from Acting Director of the Bureau of Land Management (BLM) William Perry Pendley, a right wing anti-government zealot who was appointed to head the BLM without Senate approval.

Pendley was scheduled to visit the new Grand Junction BLM office on the morning of its first opening day.

The protest was at the BLM’s new offices at 760 Horizon Drive, which is also the same building that houses the corporate offices of oil and gas purveyor Chevron.

Bonsai Design sued over injuries incurred on Vail’s Game Creek Zipline

A platform at Vail Resort’s Game Creek Canopy Tour zipline attraction.

A lawsuit** (pdf) was filed in District Court last July against Las Colonias Business Park anchor tenant Bonsai Design and Vail Resorts for injuries a guest incurred on Vail Resort’s Game Creek Zipline Tour on July 7, 2017.

Lisa Cowles of Wisconsin filed the lawsuit (pdf) on July 22, 2019, challenging the “unreasonably dangerous and defective design, manufacture, installation, and maintenance of the ‘Game Creek’ zip-line course in Vail, Colorado.” Bonsai manufactured and installed the zipline course in 2015, and Vail Resorts operates it.

Why I voted “no” on Proposition DD

Proposition DD on the November 5 ballot would legalize gambling on amateur and professional sports and tax the proceeds at a rate of 10% to pay for “water projects,” purportedly projects proposed in the Colorado Water Plan.  I wasn’t sure how to vote on Prop DD until I did some research on it and put some thought into. What I found convinced me to vote “no.”

Here’s what I found out: