Things are getting pretty bad on the Medicare side of the business. Anyone paying attention should probably get ready for some major restructuring.
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Definitely more change in the way. None of this is accidental.
The Wellcare Medicare CM team had their townhall and they will be implementing a whole new process Oct 1 which sounds hellish. You will be bled dry
The WellCare Product team announced their reorg yesterday. I’m so confused about the lack of technology, modernization and avoidance of automation plus hostility towards anyone outside of Product. Then they repurposed a vendor manager vp into a data science vp with 0 background
Your kidding me.
The Medicare Advantage Expedited Appeals Team was Chopped back in Feb 2026. The Team was broken up and assigned to different Appeals teams or laid off. Supervisor, Lead, and 2 seniors laid off in 1 day. and the rest moved to different teams. Then replaced by the Post service. This started in February. 137 laid off, then 2 small 50 people layoffs, then the VSP and now ISP. 61,000 down to 59, 000 and some change. More to Come. Off shoring anything they can to save/make a buck. going all in on AI. (Will be 5-10 years before AI can do claims work) Let just give a 5-year-old kid (AI) care keys and a shopping list and send it to the store. The Train wreck will be awesome!
@gc “Did you ask Ognizant/Trizetto what to do?,” I asked sarcastically.
I'm in Arizona and couldn't agree more. Since this whole thing started, it takes 3-4 escalated emails and must include VP level to get any claims or dispute answers. Had a provider with a refund notice, I was told it was 100% human error just send the provider an email. Seriously? What about CMS regulations of appropriate notification which I said, nope !! just send an email its an error. Recred, don't have a business license? Hey it's ok with Centene, told just ignore it for now. WOW
I want out, this ship is sinking fast and is 100% a walking compliance law suit just waiting to happen.
@e6 Most likely deserves to be locked up In prison. Really that is where every single one of the executives for these large for-profit health insurance corporations belong.
@e6 All we’ve heard from the company and leadership within Medicare is that, medicare is on track to breakeven and we are making progress to profitability. Even if the rumors of him being out is true, then what they’ve been telling us about Medicare is a lie, lol. You don’t force a top leader out if they are doing such a “great” job.
Rumblings of Medicare CEO is leaving (not by choice) by end of the year.
Something is definitely going on because the senior leadership is all shook up. Every meeting I have it’s getting more and more frantic about proving quality scores, holding the provider offices accountable. It’s been really weird the last two weeks.
Exactly. Didn't we just go through a major restructuring? Why put a statement like that in here and then not elaborate on it. Fake news.
Can you elaborate?
Like worse than the wings falling off of the plane like in the past year or so? How much worse could it really get?
Yeah, I went there.