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Even with a $5000 deductible, if you have your MD/lab/provider submit all bills to insurance first, there will be significant cost savings...probably a 60%-75% cost savings. This is because you pay the prenegotiated rate ...even before you meet your deductible.
For example, a $750 charge for X-Rays might have a prenegotiated cost of $270. You only owe $270 in this case. The key is to use the in-network providers, because they have to charge you the prenegoiated rate.
You wait for the insurance company to get the full bill directly from provider ($750). Within a few weeks the insurance company will mail you notice of the original $750 charge and they will list the amt you owe and the 'allowed rate' which is the prenegotiated rate. This sameple it would be $270. Then you send the $270 to the provider. You always wait for this notice from your insurance company before you pay any bills that have been submitted to them. The provider gets the same type of notice from insurance company and will adjust the price to the prenegotiated rate. You won't know the prenegotiated rate until the bill is submitted to the insurance company.
Always submit ALL charges to the insurance company so you can find out your discount!!! Even when you won't meet the deductible that given year.
The process you describe used to be SOP for many providers. But now most are moving to up-front payment of co-pays and deductibles (some providers are better at computing these negotiated prices than others - some will give you an exact amount to the penny - others will guesstimate - send you an extra bill you if they're low - or refund an excess payment if they're high). Doesn't mean you won't get a negotiated rate if there is a negotiated rate - but you have to pay more or less what you owe up front.
Also - if your insurance is somewhat behind in things - the provider will require advance payment of co-pays and deductibles depending on the best information available. For example - I met my Medicare deductible in January. But when I went to a doctor in February - Medicare didn't show that I had met my deductible. So I had to pay the deductible again before being treated (doctor's office later sent me a refund).
I do agree about submitting all bills to the insurance company. Except if the cash price is lower than your co-pay (in my case - that only applies to certain prescription drugs). Robyn
P.S. I was in a PPO before I went on Medicare. PPO discounts were normally in the 5-35% range. I never saw one as high as 60-75%.
...Fwiw, just found out BCBS is no longer offering hd-F in WI and other states for 2014, although they are still listed on the Medicare.gov site. A new carrier has been added. I'll have to make some calls on Mon. for current rates and info. My email inbox has been conspicuously devoid of the usual solicitations I normally get around during open-enrollment.
I took a look - and Florida Blue (formerly BCBS) isn't offering high deductible F where I live either for next year. It was definitely offering it last year when I first bought my Medigap policy.
If I had to guess - this is all part of the ongoing effort to divide Medicare people into the "haves" in traditional Medicare with expensive Medigap policies - and the "have nots" on MA plans and Medicare/Medicaid.
FWIW - my understanding is that if a person has a particular type of Medigap policy - he or she is entitled to keep it even if the company no longer offers the plan - as long as the carrier doesn't leave the state. Don't know the details of how that works - because I've never gone through it before. Do you currently have a high-deductible F plan from BCBS (can't remember)? Robyn
I took a look - and Florida Blue (formerly BCBS) isn't offering high deductible F where I live either for next year. It was definitely offering it last year when I first bought my Medigap policy.
If I had to guess - this is all part of the ongoing effort to divide Medicare people into the "haves" in traditional Medicare with expensive Medigap policies - and the "have nots" on MA plans and Medicare/Medicaid.
FWIW - my understanding is that if a person has a particular type of Medigap policy - he or she is entitled to keep it even if the company no longer offers the plan - as long as the carrier doesn't leave the state. Don't know the details of how that works - because I've never gone through it before. Do you currently have a high-deductible F plan from BCBS (can't remember)? Robyn
BCBS rep told me last year that hd-F hadn't been offered for a while, but then BCBS got back into that market. Now, they're out, again. Yes, from what rep told me yesterday, it is grandfathered.
I have an MA through UHC - not liking what I'm reading and hearing about UHC MA's. Did have a payment issue with UHC MA in 2012, internet is rife with stories identical to mine, UHC pretends it doesn't get the MA claims, gives the providers a real hassle on demanding they resend/fax/call on claims submitted only to ultimately issue a denial.
C-Span caller last week said major provider in TN won't take AARP UHC MA, because "they don't pay." Which confirms my experience and all the numerous identical stories on the internet. UHC modus operandi is deny, deny, deny, say they never got the paperwork, never send EOBs, providers end up billing patients, who end up fighting with stupid/incompetent/unhelpful/lying UHC CS. A PITA.
Plus, UHC is dropping MA providers all over the country. So far, they "say" my network hasn't changed, but I don't trust them - at all. Also, lots of complaints about Optum not properly/ignoring filling drug orders, not that I take any.
Plus, UHC/Optum s.c.r.e.w.e.d over son/dil over earlier this year denying a claim from an in-network provider, saying provider was not in-network when it clearly - both on UHC website and provider end - was. Not sure if they finally got them to pay.
I think UHC is crooked in its administration of MA's - I don't want to be sick and having to fight with them on issues. Other MA's around here don't have the extensive provider network UHC "currently" has, however.
So, considering an hd-F or, very reluctantly, a Medigap. Since I never doctor, it really bugs me to have to spend over $2k a year for insurance I will rarely use, possibly not for another 15 years.
Last edited by Ariadne22; 10-26-2013 at 04:35 PM..
BCBS rep told me last year that hd-F hadn't been offered for a while, but then BCBS got back into that market. Now, they're out, again. Yes, from what rep told me yesterday, it is grandfathered.
I have an MA through UHC - not liking what I'm reading and hearing about UHC MA's. Did have a payment issue with UHC MA in 2012, internet is rife with stories identical to mine, UHC pretends it doesn't get the MA claims, gives the providers a real hassle on demanding they resend/fax/call on claims submitted only to ultimately issue a denial.
C-Span caller last week said major provider in TN won't take AARP UHC MA, because "they don't pay." Which confirms my experience and all the numerous identical stories on the internet. UHC modus operandi is deny, deny, deny, say they never got the paperwork, never send EOBs, providers end up billing patients, who end up fighting with stupid/incompetent/unhelpful/lying UHC CS. A PITA.
Plus, UHC is dropping MA providers all over the country. So far, they "say" my network hasn't changed, but I don't trust them - at all. Also, lots of complaints about Optum not properly/ignoring filling drug orders, not that I take any.
Plus, UHC/Optum s.c.r.e.w.e.d over son/dil over earlier this year denying a claim from an in-network provider, saying provider was not in-network when it clearly - both on UHC website and provider end - was. Not sure if they finally got them to pay.
I think UHC is crooked in its administration of MA's - I don't want to be sick and having to fight with them on issues. Other MA's around here don't have the extensive provider network UHC "currently" has, however.
So, considering an hd-F or, very reluctantly, a Medigap. Since I never doctor, it really bugs me to have to spend over $2k a year for insurance I will rarely use, possibly not for another 15 years.
My sister lives in TN and she said her doctors and the largest hospital there wouldn't take the UHC Advantage PPO either. I think UHC Advantage plans are in real trouble with Medicare and the Medicare star ratings and are trying to restructure as best they can. Their problem is customer service, they'd better get it fixed sooner than later. Could be the MA providers are dropping UHC.
As far as Medicare itself goes it is obviously going to change. And soon. I'm thinking something more on the line of HMOs and a combo of Medigap/Advantage within them. You might not have to worry about 15 years,
It is interesting about the HD F. Looks like the insurance companies aren't making money on them. Really though, they are the best deal in Medigap IMO.
Actually - having gone to Cornell and Harvard Law School - I know there's an awful lot of "networking" that goes on after school - if one is interested in that kind of thing - for whatever reason. I think the lawsuits that result from this mess (and there will probably be lawsuits) will be interesting circuses to watch. Robyn
...So, considering an hd-F or, very reluctantly, a Medigap. Since I never doctor, it really bugs me to have to spend over $2k a year for insurance I will rarely use, possibly not for another 15 years.
Or you might need the insurance tomorrow. You never know. That's why you buy insurance - because you don't know what will happen tomorrow - next year - or 5 or 10 years down the road.
And the way it works with MA/Medigap - you can't change from MA to Medigap without medical underwriting except under limited circumstances (I'm sure you know that - but perhaps other people don't). Robyn
BCBS rep told me last year that hd-F hadn't been offered for a while, but then BCBS got back into that market. Now, they're out, again. Yes, from what rep told me yesterday, it is grandfathered.
I have an MA through UHC - not liking what I'm reading and hearing about UHC MA's. Did have a payment issue with UHC MA in 2012, internet is rife with stories identical to mine, UHC pretends it doesn't get the MA claims, gives the providers a real hassle on demanding they resend/fax/call on claims submitted only to ultimately issue a denial.
C-Span caller last week said major provider in TN won't take AARP UHC MA, because "they don't pay." Which confirms my experience and all the numerous identical stories on the internet. UHC modus operandi is deny, deny, deny, say they never got the paperwork, never send EOBs, providers end up billing patients, who end up fighting with stupid/incompetent/unhelpful/lying UHC CS. A PITA.
Plus, UHC is dropping MA providers all over the country. So far, they "say" my network hasn't changed, but I don't trust them - at all. Also, lots of complaints about Optum not properly/ignoring filling drug orders, not that I take any.
Plus, UHC/Optum s.c.r.e.w.e.d over son/dil over earlier this year denying a claim from an in-network provider, saying provider was not in-network when it clearly - both on UHC website and provider end - was. Not sure if they finally got them to pay.
I think UHC is crooked in its administration of MA's - I don't want to be sick and having to fight with them on issues. Other MA's around here don't have the extensive provider network UHC "currently" has, however.
So, considering an hd-F or, very reluctantly, a Medigap. Since I never doctor, it really bugs me to have to spend over $2k a year for insurance I will rarely use, possibly not for another 15 years.
Ariadne22
If your having those kinds of problems maybe you should seriously consider switching before you get sick.
Many people such as yourself consider themselves healthy ---- until one day you wake up and something is not right. There's usually no warning lights that appear before you. I know what you mean about the expense, but if you wind up needing it, it will be invaluable to you. My supplemental policy has probably paid out over $100,000 towards my medical bills. How would you like to have to pay that out of your retirement savings. My $3,000 a year will never repay this in my life time.
Also - for people like Ariadne22 - Plan N might make sense. To me - it seems to be kind of a substitute for the "high deductible F" plan. Where I live - it's about $130/month for AARP UHC plan N - about $175/month for AARP UHC regular plan F. Think the deductibles as between the 2 plans are the most important issue in terms of pricing (I'm not sure - there may be other things as well). My husband and I know we'll eat through our deductibles every year even if we only get the "routine maintenance" we're supposed to get in our particular situations - but plan N might work for other people. Robyn
I went on the ACA site to compare what I would have to pay.
Wow! I already pay 994 per month and their comparable policy is
1134. No thanks.
Let me beat 'somebody' to the stock answer....
but look at all the new benefits you will get! Maternity coverage, oral and vision care for children,coverage past 42 zillion dollars, and etc, etc, etc....all those things you are missing now.......
The lifetime limit cap, BTW, got me curious about how much it is worth and to how many people.
This doesn't make it sound like it should have added much, if anything, to a policy and that there wasn't a lot of need for it anyway.
Looks like a feel good addition to make those having to cover the needs of others feel like they are getting something valuable .
It is estimated that approximately 20,000 to 25,000 people have exceeded limits with their current health insurance plans.
Premiums would increase by less than one-half of one percent if limits were increased to $10 million. The impact of lifetime limits: PwC US
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