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But they wouldn't collect CO-INSURANCE at the time of the visit and would bill that after the visit. They can bill you, you just don't have to pay the bill until Medicare and your insurance company have paid their portion...if there is a delay in that, then it will look like they are billing you. You need to be aware of what your plan states so you don't pay it by mistake.
We're talking about ADVANTAGE. Not Original Medicare.
And, we're talking about UHC not processing the bill at all. So, when UHC doesn't process, there is no way for anyone to know what they do or don't owe.
Also, there is NO co-insurance for ordinary doctor visits under ADVANTAGE. Just a copay, collected at the time of the visit. Which is what I've been talking about.
Further, NOTHING goes to Medicare for payment for those insured under ADVANTAGE. NOTHING.
UHC approves or denies via Medicare guidelines, and pays provider directly. CMS/Medicare is totally out of the picture.
My whole issue was UHC's lousy processing of Advantage claims.
Ariadne - it sounds like you are in a great position to switch now, and that is definitely right for your situation. Ours is tricky, as my Dad's medical costs are high so the choice is less clear. I am also accustomed to all of the billing/claim/processing problems, and your experiences are just a typical month for us already. Actually, they are not that bad, and I basically follow up on almost every claim and expect screw ups, so I get less disappointed. Sad, but true. I agree with you though - it is a nightmare and you don't want to deal with this crap as you get older. Honestly, there are so many mistakes on bills/EOBs already with his current (expiring...) CIGNA plan that it really seems like fraud to me. If I wasn't here to intercept these bills, my Dad would just pay them. I think about all the seniors out there that are managing this themselves, and some in not the greatest health or mindset and it really upsets me. I actually work in health care, and I find this mess confusing. Some of the bills he receives are so opqaue you can't even tell what they are for.......
But it sounds like my Dad's option for a UnitedHealthCare Medicare Advantage plan (employer retiree funded) is very different from yours. It is not an HMO, but is a PPO that accepts payment from all providers (in network and out of network) and is just for his group of retirees. There are no visit co-pays, but there is a yearly deductible of like $100 and then they pay 90% (we pay 10% co-insurance) until he reaches $1300 out of pocket for a year. We'll reach that for sure. Then they pay 100%. The monthly premium for him will be like $150 or so total - and it includes the Advantage plan, Part D equivalent, dental, etc..
I may just try it for 1 year.... but I'm still going to do a bunch of comparisons/calculations this week, and go to a meeting tomorrow to get more details from UHC/his retiree plan.
Robyn - The things we are wondering if UHC Medicare Advantage *might* cover are a few things that Medicare currently doesn't cover, but his CIGNA employer secondary insurance does.... and they cover these automatically without us having to do any pre-determination or appeal. Some blood tests (ex. zinc), compression stockings, gloves as a monthly medical supply (needed for management of two of his medical problems), infusion supplies with Home care services, physical therapy beyond the yearly cap, better crutches then Medicare allows appropriate for his height/weight, better accessories for his wheelchair then Medicare allows and more. I sense that UHC Medicare Advantage will likely reject all of these... and that even though they claim we can appeal and/or ask the doctor to send a pre-determination initially, part of me wonders if it will be like Medicare, and no one actually ever wins an appeal?
Basically, my Dad's prior employer is the State of Illinois. They are broke. The politicians are a bunch of spineless, self-serving managers that have underfunded the state pension program for years and just ignored it, and are now selling out the state brick by brick. One way they are trying to save money is by cutting back on the health benefits of folks like my Dad that are already retirees. And this upcoming cut back is a bad one.... It is clear they are actually trying to scare off people like my Dad.... who need good health insurance the most..... by making it unwieldy (now with co-insurance for every visit), with more restrictions, and by cutting benefits.
But it still may look (on paper) better then Medicare and Medigap alone, when you do the numbers....
Thanks for your input/discussion guys. And thanks for letting me vent a little!
But it sounds like my Dad's option for a UnitedHealthCare Medicare Advantage plan (employer retiree funded) is very different from yours. It is not an HMO, but is a PPO that accepts payment from all providers (in network and out of network) and is just for his group of retirees. There are no visit co-pays, but there is a yearly deductible of like $100 and then they pay 90% (we pay 10% co-insurance) until he reaches $1300 out of pocket for a year. We'll reach that for sure. Then they pay 100%. The monthly premium for him will be like $150 or so total - and it includes the Advantage plan, Part D equivalent, dental, etc..
My sister was pretty much in the same position as your dad last year. She taught school, the state offered the Advantage plan to her at age 65 as well (and that only) and, oddly enough, it was also thru United Healthcare. A PPO at that. At first, her thinking was that it was thru AARP and so has to be good. But she and I went thru all the options. It turned out that the largest and best hospital nearest her would not take the UHC PPO plan. Neither would her doctors. So, she eventually went with a Medigap high deduct plan F with UHC. Their Medigap plans are good. A different world than their Advantage plans.
I don't know where your dad lives in IL but if its in a rural area, Advantage plans just don't work very well. But if he lives in an area where the Advantage plans are popular you might find a better plan that UHC. Medicare Find-A-Plan is a good resource, they will list all the plans including costs and their star ratings. And you can drill down thru each plans star ratings to the point of customer satisfaction, quality of plan, those leaving, etc. Before making a final decision IMO you ought to look around, not take UHCs word. You might find a better quality plan, maybe even one of the best with zero premiums (which, of course, the state won't tell you about as they have a deal with UHC).
Also, talk to your dad's doctors (ummm, the office insurance person there). They can tell you whats good and/or bad. My sister did that also.
Honestly, there are so many mistakes on bills/EOBs already with his current (expiring...) CIGNA plan that it really seems like fraud to me.
CIGNA is pretty bad, very low ratings, from what I read.
Quote:
Originally Posted by sfcambridge
But it sounds like my Dad's option for a UnitedHealthCare Medicare Advantage plan (employer retiree funded) is very different from yours. It is not an HMO, but is a PPO that accepts payment from all providers (in network and out of network) and is just for his group of retirees. There are no visit co-pays, but there is a yearly deductible of like $100 and then they pay 90% (we pay 10% co-insurance) until he reaches $1300 out of pocket for a year. We'll reach that for sure. Then they pay 100%. The monthly premium for him will be like $150 or so total - and it includes the Advantage plan, Part D equivalent, dental, etc..
Since it's an employer-retiree plan, hopefully UHC won't play games with the State of Illinois and will process and pay properly. Not holding my breath. If you do go with this, looking forward to hearing your experience.
Quote:
Originally Posted by sfcambridge
I may just try it for 1 year.... but I'm still going to do a bunch of comparisons/calculations this week, and go to a meeting tomorrow to get more details from UHC/his retiree plan.
With your father's health, it is unlikely you will have the option of "trying it." Once enrolled, most likely you'll be locked in, unless UHC drops coverage entirely - OR their change in networks allows a Guaranteed Issue for him (I don't think change in networks will be sufficient to trigger a GI event).
Annual Open Enrollment Period for Medicare does NOT mean guaranteed acceptance - except in limited circumstances.
The health questionnaires required by the Medigaps - even at Open Enrollment - keep many locked into their old plans because new carriers won't take them.
Last edited by Ariadne22; 11-18-2013 at 10:20 PM..
Some, if accepted might just apply an "existing condition waiting period", usually 6 months.
One can apply while staying covered under the old plan, to see what would be offered.
We're talking about ADVANTAGE. Not Original Medicare.
And, we're talking about UHC not processing the bill at all. So, when UHC doesn't process, there is no way for anyone to know what they do or don't owe.
Also, there is NO co-insurance for ordinary doctor visits under ADVANTAGE. Just a copay, collected at the time of the visit. Which is what I've been talking about.
Further, NOTHING goes to Medicare for payment for those insured under ADVANTAGE. NOTHING.
UHC approves or denies via Medicare guidelines, and pays provider directly. CMS/Medicare is totally out of the picture.
My whole issue was UHC's lousy processing of Advantage claims.
I am talking about Advantage plans and just because your plan has a co-pay doesn't mean they all do....
Quote:
Originally Posted by sfcambridge
Ariadne - it sounds like you are in a great position to switch now, and that is definitely right for your situation. Ours is tricky, as my Dad's medical costs are high so the choice is less clear. I am also accustomed to all of the billing/claim/processing problems, and your experiences are just a typical month for us already. Actually, they are not that bad, and I basically follow up on almost every claim and expect screw ups, so I get less disappointed. Sad, but true. I agree with you though - it is a nightmare and you don't want to deal with this crap as you get older. Honestly, there are so many mistakes on bills/EOBs already with his current (expiring...) CIGNA plan that it really seems like fraud to me. If I wasn't here to intercept these bills, my Dad would just pay them. I think about all the seniors out there that are managing this themselves, and some in not the greatest health or mindset and it really upsets me. I actually work in health care, and I find this mess confusing. Some of the bills he receives are so opqaue you can't even tell what they are for.......
But it sounds like my Dad's option for a UnitedHealthCare Medicare Advantage plan (employer retiree funded) is very different from yours. It is not an HMO, but is a PPO that accepts payment from all providers (in network and out of network) and is just for his group of retirees. There are no visit co-pays, but there is a yearly deductible of like $100 and then they pay 90% (we pay 10% co-insurance) until he reaches $1300 out of pocket for a year. We'll reach that for sure. Then they pay 100%. The monthly premium for him will be like $150 or so total - and it includes the Advantage plan, Part D equivalent, dental, etc..
I may just try it for 1 year.... but I'm still going to do a bunch of comparisons/calculations this week, and go to a meeting tomorrow to get more details from UHC/his retiree plan.
Robyn - The things we are wondering if UHC Medicare Advantage *might* cover are a few things that Medicare currently doesn't cover, but his CIGNA employer secondary insurance does.... and they cover these automatically without us having to do any pre-determination or appeal. Some blood tests (ex. zinc), compression stockings, gloves as a monthly medical supply (needed for management of two of his medical problems), infusion supplies with Home care services, physical therapy beyond the yearly cap, better crutches then Medicare allows appropriate for his height/weight, better accessories for his wheelchair then Medicare allows and more. I sense that UHC Medicare Advantage will likely reject all of these... and that even though they claim we can appeal and/or ask the doctor to send a pre-determination initially, part of me wonders if it will be like Medicare, and no one actually ever wins an appeal?
Basically, my Dad's prior employer is the State of Illinois. They are broke. The politicians are a bunch of spineless, self-serving managers that have underfunded the state pension program for years and just ignored it, and are now selling out the state brick by brick. One way they are trying to save money is by cutting back on the health benefits of folks like my Dad that are already retirees. And this upcoming cut back is a bad one.... It is clear they are actually trying to scare off people like my Dad.... who need good health insurance the most..... by making it unwieldy (now with co-insurance for every visit), with more restrictions, and by cutting benefits.
But it still may look (on paper) better then Medicare and Medigap alone, when you do the numbers....
Thanks for your input/discussion guys. And thanks for letting me vent a little!
A group Advantage plan is not going to be the same as a plan off the public market. In the case of your Dad's plan, they are self-funded and if the claims are not getting paid it's because the state hasn't sent over the money to pay the claims.
1. More on billing problems 2. Medical underwriting
I am wondering if my Kaiser Medicare Advantage Plan in Los Angeles County is fairly unique in having hundreds (maybe thousands) of doctors on salary? That means there is never any issue about the doctors getting paid either. I wonder if the elimination of the whole inefficient mess of billing paperwork every time someone sees a doctor is part of the reason Kaiser is able to offer more bang for the buck?
On another matter, when I signed up with Kaiser four and a half years ago (upon turning 65), it never occurred to me that I would be subject to medical underwriting if I elected to jump ship later on. I was simply continuing my existing employer coverage with Kaiser, as I was able to keep my same doctor, same medical record number, same navigation of the system, etc. The only difference was that there was no longer any connection whatsoever with the former employer. I did receive a new membership card indicating Medicare Advantage, but with the same medical record number.
Although I will never move away from this area (Southern California is a fantastic fit for me and I plan to die in the townhouse I own because it is a good fit for me too) and although I don't see myself becoming dissatisfied with Kaiser, the latter could conceivably happen. I hope it doesn't, and one reason is the potential inability to get a Medigap plan because of medical underwriting.
Does anyone have insight into the underwriting issue, and if so, can it be explained in a short paragraph?
I am wondering if my Kaiser Medicare Advantage Plan in Los Angeles County is fairly unique in having hundreds (maybe thousands) of doctors on salary? That means there is never any issue about the doctors getting paid either. I wonder if the elimination of the whole inefficient mess of billing paperwork every time someone sees a doctor is part of the reason Kaiser is able to offer more bang for the buck?
On another matter, when I signed up with Kaiser four and a half years ago (upon turning 65), it never occurred to me that I would be subject to medical underwriting if I elected to jump ship later on. I was simply continuing my existing employer coverage with Kaiser, as I was able to keep my same doctor, same medical record number, same navigation of the system, etc. The only difference was that there was no longer any connection whatsoever with the former employer. I did receive a new membership card indicating Medicare Advantage, but with the same medical record number.
Although I will never move away from this area (Southern California is a fantastic fit for me and I plan to die in the townhouse I own because it is a good fit for me too) and although I don't see myself becoming dissatisfied with Kaiser, the latter could conceivably happen. I hope it doesn't, and one reason is the potential inability to get a Medigap plan because of medical underwriting.
Does anyone have insight into the underwriting issue, and if so, can it be explained in a short paragraph?
If you jump ship, as you say, because you want to, the new company could (and most likely will) subject you to medical underwriting. There are some circumstances where you have guaranteed issue, like if Kaiser stopped offering plans or went bankrupt but most likely you will be underwritten if you change.
I have been fearful of committing to a Medicare Advantage and leaving Medicare because I don't want to lose my chance to get Medigap without underwriting if our Medicare Advantage experience is a flop. However, in our State, currently Blue Cross allows you to sign up for a Medigap anytime in the year with no underwriting. I have no idea why they do this, but this has been my "fall back" plan - even now. Of course, what if they change this policy? They could.... but also what is unclear is whether when Obamacare really kicks in in 2014 and you are not allowed to discriminate based on pre-existing conditions, whether this will apply to people signing up for Medigaps as well. I asked this question last year, and no one would answer it. Anyone here know?
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1. More on billing problems 2. Medical underwriting
