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Old 06-25-2012, 11:19 PM
 
41,648 posts, read 44,893,785 times
Reputation: 12798
Quote:
Originally Posted by Ariadne22 View Post
I'm on a UHC Advantage in WI. No premium other than $100/mo I pay for Medicare Part B. $5,000 cap on out-of-pocket, copays $20/PCP, $40/Specialist, $50/ER. Includes drug coverage. I rarely doctor.

Haven't had any trouble until recently when one in-network dermatologist won't send requested paperwork to UHC, but bills me instead for the FULL amount. I already paid my $40 copay. That should be it. Instead, he sends me bills for $422. UHC has twice denied the claim because of improper documentation.

Doctor didn't sent requested paperwork to UHC, despite notes on their bills that they have submitted the claim three times. UHC says claim was only submitted twice. UHC tells me the issue is between doctor and them and won't talk to me about it, won't even tell me what paperwork it is they need from Dr. Any contract binding between Dr. & UHC doesn't let me off the hook because I am not a party to it. Doc can send this bill to a collection agency.

I wrote lengthy letters last week to billing dept. supervisor of Dr.'s practice group, Dr. himself, UHC Appeals and Grievances - AND - filed a report against that practice group with the Better Business Bureau. Got a VM from the billing supervisor two days later who said she had talked to "John at UHC and they are processing the claim." I don't believe this b/c UHC didn't have the paperwork when I sent the letter and they sure didn't get it two days after I wrote the letter. I think in the end I could win the issue legally, but what an unnecessary hassle.

Problem is Medicare/Advantage reimbursements are minuscule. I believe this practice group tries to intimidate people to pay when they aren't required to. Couple stories on the internet bear this out as far as this particular Dr. is concerned. Needless to say, I won't visit this doctor again or anyone in his practice group.

I could solve this w/a Supplement b/c then Dr. would have to explain to Medicare why they aren't honoring the Medicare reimbursement. Also w/Supplements, there is no such thing as in-network, out-of-network. But, Supplements are costly. Very costly, and don't cover drugs w/o an extra charge. Rates vary by state. Rates in WI are on the higher side. TN, Ark, etc. rate can be half what of what we have to pay here. WI good Supp for someone 69 y/o about $165/mo - w/o drugs. And the rates go up every year. I don't take any medication and have no intention of having drug coverage.

So, you pick your poison. I'm so fed up, I'm even thinking of dropping Medicare Part B ($1,200/yr). Then, I could pay that doctor his $422 from the $1200/yr I wouldn't be paying Medicare - and wouldn't have the headache. j/k
When using any managed healthcare you have to be every careful to stay for all providers within the network of providers who they have contratcs with. Not all services at a hospital are always covered such as labs;pathlogist etc they use.If not covered by contract then your on hook for full charges and they do not have to file claim with advantage plan at all;leaving that upto you, When you enter you sign final responsibilty for payment of services. But if that doctor was in netwrok and had a contract with that advantage plan then they should have handled the entire matter with their contracted doctor.
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Old 06-26-2012, 05:50 AM
 
Location: Lubbock, Tx
4,857 posts, read 1,725,292 times
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Well, we'll probably take the Part D. My wife takes alergy meds and hormones. But from what I've seen, in a lot of cases, doctors are treating more with drugs than anything else. Even heart ailments are most often treated with drugs. Even blockages are supposed to be treated with drugs first before they try open heart or angiograms. But I've heard of people paying $500 a month per person for supplimental insurance, I'll consider the alternative.
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Old 06-26-2012, 07:16 AM
 
Location: Here
2,614 posts, read 3,578,237 times
Reputation: 4180
Quote:
Originally Posted by matisse12 View Post
So the 'Medicare Advantage' plans are the way to go?

I don't have a good understanding yet, as I'm turning 65 in four months and have not yet been able to figure out the options and details.
You're right, it is confusing. I met with three different independent health insurance agents to get the low down and understanding of the options available, and that helped tremendously to clear the fog. I also made phone calls to Medicare to learn more about what is/what is not covered.

For me, Advantage plan is the best. Each person needs to make a decision that is dependent on what works best for them.
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Old 06-26-2012, 11:34 AM
 
Location: Wisconsin
13,866 posts, read 17,855,828 times
Reputation: 6486
Quote:
Originally Posted by texdav View Post
When using any managed healthcare you have to be every careful to stay for all providers within the network of providers who they have contratcs with. Not all services at a hospital are always covered such as labs;pathlogist etc they use.If not covered by contract then your on hook for full charges and they do not have to file claim with advantage plan at all;leaving that upto you, When you enter you sign final responsibilty for payment of services.
Which is why I was very careful to choose an in-network doctor. They were billing me an additional $187 for the office visit, in spite of the copay. In addition, they were billing for outpatient services. I expect I might have to pay part or all of the outpatient, but I have NO responsibility for the office visit beyond the $40 copay which I paid at the time of the appointment.
Quote:
Originally Posted by texdav View Post
But if that doctor was in netwrok and had a contract with that advantage plan then they should have handled the entire matter with their contracted doctor.
Drs. office lied about sending in necessary paperwork, lied about calling UHC, and insisted on billing me instead, saying it was my insurance company's fault. UHC refused to accept the claim from me or even tell me what it was they needed from the doctor.

Clearly, this practice group/doctor is playing games because they don't like the UHC Advantage reimbursements. He is located in a very affluent area and is probably able to shake the full fee out of many of his patients who believe their story that it is all UHC's fault.

It isn't. I've never experienced this with any other provider. Just paid the copay and that was it.

I told that doctor and his billing people if they didn't want to honor their agreement with UHC, they should remove themselves from the network and not put their patients through this hassle.
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Old 06-26-2012, 11:47 AM
 
Location: Wisconsin
13,866 posts, read 17,855,828 times
Reputation: 6486
Quote:
Originally Posted by Prairieparson View Post
Well, we'll probably take the Part D. My wife takes alergy meds and hormones. But from what I've seen, in a lot of cases, doctors are treating more with drugs than anything else. Even heart ailments are most often treated with drugs. Even blockages are supposed to be treated with drugs first before they try open heart or angiograms. But I've heard of people paying $500 a month per person for supplimental insurance, I'll consider the alternative.
Hormones won't be covered under Part D, I don't think. The $500/month for a couple is very realistic for a Supplement, if you are including drugs. It amounts to about $250/person. Drug coverage alone is $40/mo. So, the Supplement cost is $210, probably a bit high for a 65-yo. Rate should be more in the area of $140-$175, depending on location, but those rates rise every year.

When I went on Advantage, married couple in their 80s at the information meeting said they could no longer afford the $300 ea. ($600/mo. for both) it was costing them to keep the Supplement. They'd just received another rate increase. She had had myriad health issues and wouldn't drop the Supplement, said the coverage was great. But, he was healthier and was going on Advantage, saving them $300/mo. Of course, he would then be subject to copays/coinsurance with Advantage.
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Old 06-26-2012, 01:28 PM
 
Location: NY & Fl
10,967 posts, read 7,569,248 times
Reputation: 8952
Quote:
Originally Posted by Prairieparson View Post
Well, we'll probably take the Part D. My wife takes alergy meds and hormones. But from what I've seen, in a lot of cases, doctors are treating more with drugs than anything else. Even heart ailments are most often treated with drugs. Even blockages are supposed to be treated with drugs first before they try open heart or angiograms. But I've heard of people paying $500 a month per person for supplimental insurance, I'll consider the alternative.
$500 a month for a supplement plan is outrageous.
If you 'heard of ' it I'd have to ask you where and be totally disinclined to believe it.
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Old 07-03-2012, 04:14 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 7,717,081 times
Reputation: 3858
THE BIGGEST PROBLEM WITH NOT HAVING A MEDIGAP POLICY IS IT IS EASY TO RUN OUT OUT OF HOSPITAL DAYS IF YOU GET SICK.

We ran into this problem with my late MIL - who didn't have a Medigap policy when my husband and I were finally asked for advice. She was about to run out of Medicare hospital days. But - luckily - we kept her out of the hospital just long enough during a lengthy illness so she could apply for a Medigap policy. I forget whether it was guaranteed issue for her then - or whether she had to be underwritten - or whether she had to pay a premium over standard rates (we're talking 10+ years ago). But - without the Medigap policy - she would have run out of Medicare hospital days before she died.

I have a very simple philosophy about this. If you can afford it - buy the best. Even if you have to give up your iPhone/unlimited data plan or next vacation. If you cannot possibly afford this without knowing where your next meal or mortgage payment will come from - you have to go with Plan B (which may well be a Medicare Advantage plan - or perhaps combined Medicare/Medicaid - the so-called Medi/Medi). Robyn
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Old 07-03-2012, 04:19 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 7,717,081 times
Reputation: 3858
Quote:
Originally Posted by old_cold View Post
$500 a month for a supplement plan is outrageous.
If you 'heard of ' it I'd have to ask you where and be totally disinclined to believe it.
Ditto for the most part. My husband and I will be paying about $180/month each. Note that in south Florida (we're in north Florida) - the rates are about 40% higher - so you'd be talking about $250/month. I can't imagine there is anywhere in the US that would be double the rates in south Florida. Robyn
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Old 07-03-2012, 04:26 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 7,717,081 times
Reputation: 3858
Quote:
Originally Posted by Ariadne22 View Post
Hormones won't be covered under Part D, I don't think. The $500/month for a couple is very realistic for a Supplement, if you are including drugs. It amounts to about $250/person. Drug coverage alone is $40/mo. So, the Supplement cost is $210, probably a bit high for a 65-yo. Rate should be more in the area of $140-$175, depending on location, but those rates rise every year.

When I went on Advantage, married couple in their 80s at the information meeting said they could no longer afford the $300 ea. ($600/mo. for both) it was costing them to keep the Supplement. They'd just received another rate increase. She had had myriad health issues and wouldn't drop the Supplement, said the coverage was great. But, he was healthier and was going on Advantage, saving them $300/mo. Of course, he would then be subject to copays/coinsurance with Advantage.
HRT (Premarin) will be covered under my part D (it doesn't even need prior approval). But it will be a $41/month co-pay. $500/couple for a Medigap policy sounds reasonable in a high priced spread part of the country - but not for a single. OTOH - I've never explored San Francisco . But if you're adding in a Part D policy - that will add about $80-100 month for a couple. Robyn
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Old 07-03-2012, 04:30 PM
 
Location: Ponte Vedra Beach FL
10,833 posts, read 7,717,081 times
Reputation: 3858
Quote:
Originally Posted by old_cold View Post
I consider it every year at renewal time.
This year I've decided to keep every statement to see just how much that 20% will add up to.
Which is no useful answer for you at this point.
Past performance is no guarantee of future performance . None of us can predict when our personal sh** might hit the fan. Robyn
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