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That is a criminal act and the doctor should be reported to CMS.
I'm not so sure that it is criminal.
Oh it IS criminal for a doctor in Medicare to bill a patient when he is unhappy what the insurance company or the government pays, or doesn't pay him. It is a violation of the Medicare Act, Medicare fraud.
Oh it IS criminal for a doctor in Medicare to bill a patient when he is unhappy what the insurance company or the government pays, or doesn't pay him. It is a violation of the Medicare Act, Medicare fraud.
You miss the point. If you've signed up for a Medigap plan (say plan F), the Medigap plan WILL pay the 20% of whatever Medicare pays the 80% of. Without question and without negotiating.
With an Advantage plan it is entirely on the insurance plan to pay your healthcare bill (less copays and/or coinsurance). And unfortunately, some insurance companies will do everything they can to avoid/delay making those payments.
Healthcare providers are well aware of the antics of insurance companies, thus the financial provision they might ask you to sign (that I previously mentioned).
Really, Medicare fraud lies many times with certain insurance companies and they way they administer their Advantage plans. There are very good Advantage plans around but it doesn't help that industry at all when the largest of them (United Healthcare) many times offers such shoddy products and services.
You miss the point. If you've signed up for a Medigap plan (say plan F), the
Medigap plan WILL pay the 20% of whatever Medicare pays the 80% of. Without
question and without negotiating.
With an Advantage plan it is entirely
on the insurance plan to pay your healthcare bill (less copays and/or
coinsurance). And unfortunately, some insurance companies will do everything they can to avoid/delay making those payments.
Would not the same rotten Insurance company avoid paying a Medigap bill in the same way that they would avoid their Advantage bill. "We never got the paperwork from the doctor"
Why would one contract be dealt with honestly and another fraudulently?
Plan F high deductible, my view: You are buying insurance that covers your Medicare deductibles with more deductibles...I cannot see the logic. To me, common sense dictates one decision: pay deductibles or insure against them.
But each of us has to choose for ourself which of the hundreds of routes to travel in this morass called insurance company governed health care and I would never instruct anyone on what they should choose.
My only interest is in finding out if any other Manhattanites are being denied Empire BCBS Medicare Advantage continued coverage or am I being discriminated against and then lied to.
Last edited by Kefir King; 10-11-2015 at 06:53 AM..
Would not the same rotten Insurance company avoid paying a Medigap bill in the same way that they would avoid their Advantage bill. "We never got the paperwork from the doctor"
Why would one contract be dealt with honestly and another fraudulently?
Plan F high deductible, my view: You are buying insurance that covers your Medicare deductibles with more deductibles...I cannot see the logic. To me, common sense dictates one decision: pay deductibles or insure against them.
But each of us has to choose for ourself which of the hundreds of routes to travel in this morass called insurance company governed health care and I would never instruct anyone on what they should choose.
My only interest is in finding out if any other Manhattanites are being denied Empire BCBS Medicare Advantage continued coverage or am I being discriminated against and then lied to.
Do a search by zip code after open enrollment starts (Oct 15th) and you will see what is being offered. It would be illegal to do as you are suggestion and I hardly think the plan is singling you out....
Would not the same rotten Insurance company avoid paying a Medigap bill in the same way that they would avoid their Advantage bill. "We never got the paperwork from the doctor"
Why would one contract be dealt with honestly and another fraudulently?
Plan F high deductible, my view: You are buying insurance that covers your Medicare deductibles with more deductibles...I cannot see the logic. To me, common sense dictates one decision: pay deductibles or insure against them.
But each of us has to choose for ourself which of the hundreds of routes to travel in this morass called insurance company governed health care and I would never instruct anyone on what they should choose.
My only interest is in finding out if any other Manhattanites are being denied Empire BCBS Medicare Advantage continued coverage or am I being discriminated against and then lied to.
Likely Empire BCBS was losing money on that particular plan and decided to close it after 2015. They have that right. But it could also be that they had low star ratings for that plan and Medicare forced them to close it. That doesn't necessarily mean that Empire BCBS is getting out of the Advantage plan business, just that particular plan. These plans are offered by geographic location (even by zip code).
You know, before going further you should do some reading. Medicare sends out a booklet Medicare And You every year. You owe it to yourself to read it very carefully, it'll answer a lot of your questions. Perhaps not all details but enough to give you a start.
I did exactly that and they seem to be offereing the same plan, same name, with a few changes ($0 premium) for 2016.
That was my thought too, but the plan seems to be in effect for 2016, in fact they sent me an ad to JOIN as of January 1.
Then what is your problem? You can't be turned down for it as long as you are enrolled in Medicare parts A&B. If you are in an Advantage plan this year and it is being offered next year you don't have to join again, you are automatically enrolled in it for next year.'
EDIT - yet you received a letter from them saying it was closing? Give them a call.
I am thinking perhaps the fact that they went from $23/month to $0 it is considered a different plan???
On the other had this year it went from $0 (2014) to $23 (2015) and membership continued automatically.
Yeah, I am going to have to get on the blower about this, perhaps even a call to CMS (the organization that runs Medicare.) I thought I'd wait 'til the official enrollment period begins on Thursday to start making a fuss.
Another wrinkle: I got an appended letter detailing how lucky I was to be able to buy a Medigap policy now that I will default to regular Medicare. This could all be a scam to sell very profitable Medigap Plans.
Would not the same rotten Insurance company avoid paying a Medigap bill in the same way that they would avoid their Advantage bill. "We never got the paperwork from the doctor"
Why would one contract be dealt with honestly and another fraudulently?
Because the carrier risk is a lot less in a Medigap - limited to the 20% not paid by Medicare (no decisions on the part of Medigap carrier).
There are virtually no complaints anywhere on Medigaps. Otoh, the complaints on MA's (and some Rx plans) are endless
vs. an Advantage where the ENTIRE cost for the Medicare services need to come from the capitation rate (anywhere between $750-$1,200/mo. per enrollee depending on state) paid by CMS to the private insurer. If the insurer pays out too much, insurer loses money.
Quote:
Originally Posted by Kefir King
Plan F high deductible, my view: You are buying insurance that covers your Medicare deductibles with more deductibles...I cannot see the logic. To me, common sense dictates one decision: pay deductibles or insure against them.
Let's do the math:
Medigap F:
$2,400 - Annual premium (many are paying $3,000/yr. and more)
....200 - Medicare copays/20% paid by Medigap $2,200 - Net cost to consumer
High Deductible Medigap F:
$....850 - Annual premium (this is high)
.....200 - Medicare copays/20% paid by consumer $1,050 - Net cost to consumer
Which consumer would you rather be??? The one paying $1,050, or the one paying $2,200???
Most years most healthy people would be paying $1,050 under an hd-F plan. And, still have the cya max cap on costs of $2,180 (plus the premium, of course).
And you ARE insuring against the deductibles - like multiple hospitalizations @ $1,260 per admission and attendant costs. Worst case scenario - $2,180 - vs. unlimited without that coverage.
Now, some states have really low Medigap premiums. In that case, an hd-F may not be as cost-effective. Also, the older and/or sicker one gets, the more likely a regular Medigap will prove more cost-effective.
So, one needs to revisit these decisions from time to time as circumstances change.
Quote:
Originally Posted by Kefir King
I am thinking perhaps the fact that they went from $23/month to $0 it is considered a different plan???
On the other had this year it went from $0 (2014) to $23 (2015) and membership continued automatically.
$0 to $23 - or $23 to $0 - premium changes. There must be some basic coverage change in the new policy other than the premium - and, too, BCBS probably doesn't want to sell a $0 premium policy.
Thus, you're "lucky."
Quote:
Originally Posted by Kefir King
Another wrinkle: I got an appended letter detailing how lucky I was to be able to buy a Medigap policy now that I will default to regular Medicare. This could all be a scam to sell very profitable Medigap Plans.
You are NOT lucky because the plan has discontinued.
You ARE lucky because you are in New York State. NYS is a guaranteed issue state.
You could have disenrolled from the Advantage (not be cancelled) at year-end and STILL have bought any Medigap WHENEVER you choose without medical underwriting - because NYS does not allow health underwriting.
From a poster who, due to health issues, did a lot of research on NY GI issues:
Quote:
Originally Posted by Never2L8
One of the reasons for the high premiums in NY is that it is not only a Community-Rated state BUT it is also a "guaranteed issue" state. Today I got an answer to an email I sent to the NYS DFS asking whether guaranteed issue rights in NY are PERMANENT ... in other words, do they ever expire? Here is their reply:
An issuer shall not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this State, nor discriminate in the pricing of such a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant.
Applicants must be accepted at all times throughout the year for any Medicare supplement insurance benefit plan available from an issuer. (11 CRR-NY 58.1
In order to be eligible for Medigap coverage, you must be enrolled in both Part A and Part B of Medicare. New York State law and regulation require that any insurer writing Medigap insurance must accept Medicare enrollee’s application for coverage at any time throughout the year.
Insurers may not deny the applicant a Medigap policy or make any premium rate distinctions because of health status, claims experience, medical condition or whether the applicant is receiving health care services. However, eligibility for policies offered on a group basis is limited to those individuals who are members of the group to which the policy is issued.
The fact that Medigap insurers in New York MUST accept ALL applicants regardless of when they apply or what their health status or history is, means that they cannot control their risk exposure and thus, they compensate for that by charging higher premiums.
The difference in premiums in Long Island versus other parts of NYS may in part be due to the fact that Medicare pays a higher rate to providers in the LI area than they do to providers in other parts of NY, and thus the 20% coinsurance (covered by the Medigaps) is also a larger amount... and the companies adjust for that by charging higher premiums. Not sure if that's why but it sounds logical.
This guaranteed issue factor is extremely important to me. I want the freedom to be able to freely switch between policies (or between having no Medigap at all, and having one) at any time I wish, for the rest of my life, without fear of ever being turned down or charged more than a perfectly healthy person would pay. Obviously this freedom comes at a price (higher premiums). Until I discovered this NYS law, I was considering relocating to a state that does not offer permanent guaranteed issue rights; I've now changed my mind and am going to start investigating locations elsewhere in NY (but not LI). I haven't checked yet but I would guess that Medigap premiums upstate are going to be lower than here on Long Island!
So, short story is only decision you need to make before December 7th is whether or not to enroll in an MA. Otherwise, you can hold off, pay the 20% here and there, if necessary - and buy a Medigap anytime you please. Get a terrible diagnosis or suffer a bad accident - fine - apply for a Medigap - within a few weeks you have coverage. Or, cancel the hd-F and get full-blown Medigap. Can't do that in most states.
Last edited by Ariadne22; 10-11-2015 at 02:16 PM..
No, my Medigap hasn't paid a single penny - but $889/yr. cya insurance beats a $2,100 yr. full Medigap premium, anytime - for me in WI. The math is discussed, here:
Seeing as how so far this year my share of Medicare expenses is $179 (including $147 Part B deductible), I would still have spent a net of $1,921 ($2,100-$179) for Medigap F insurance vs. $889 hd-F. Savings - over $1k.
Which is why I'm switching to a Medicare Savings Account Advantage plan in 2016. Two WI-based companies are offering MSA's this year. Last year it was one company, I kicked the idea around then, but held off.
Both plans have NO NETWORKS (see any Medicare provider anywhere), zero premium, deductibles of $4,000/$5,000; Medicare deposits $1,600/$2,000 in the saving account which can be used to pay any qualified medical expense (dentist, drugs, etc.) plus first dollar Medicare expenses up to the deductible; thereafter plans pay all Medicare-approved expenses 100%. Money not used is carried forward to the next year. Essentially this works like an HSA, but there is no tax write-off. Seeing as how I rarely doctor, in a few years I should have enough in the account to cover the MSA deductible should the worst happen - and won't have spent any premium dollars, either.
Presently, my exposure between hd-F premium of $889 + $2,180 deductible is the same as the first-year net exposure under the MSA - approx. $3,000. But, with an MSA, I won't pay a premium, and the govt pays me, instead. Gross Medicare charges for me this year total $307 v. $2,000 in the MSA, so it's a win.
Not too many MSA's around. This is a new product in our state - and a great deal for someone who is healthy. The fact that both are offered by smaller WI-based companies, one an arm of a highly rated medical practice mid-state, is also a plus. I wish more of our local health systems would offer their own MA's. I'd feel a lot better about joining a regular MA if its name was preceded by Aurora or Froedtert. lol
That is a very interesting plan. I read more on MSAs this afternoon, it looks good, don't see how you could lose on it especially with Froedtert getting in this (so I just read). Do you get earnings on the cash deposits?
I wonder why Medicare isn't pushing it more, could be a real demand for it.
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