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Old 02-22-2016, 03:31 PM
 
Location: louisville
4,754 posts, read 2,012,260 times
Reputation: 1713

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Quote:
Originally Posted by Weichert View Post
Thats all well and good. I guess.

However, if a person has done the research and decided that the MA plans are best for them, the next step is choosing the proper plan that best fits their needs. And that means skipping United Healthcare and any MA plans that they offer. Without exception.
I have heard that... mostly from providers (much of my work in healthcare was provider specific. Short story is making sure they got paid, even when we had the system jacked up). I didn't work for UHC (I have been recruited by them) so I won't say anything disparaging.

The industry is far, far from perfect. When faced with:

1. bureautic red tape in getting someone paid when there were issues (many times, it was provider billing errors, or clearinghouses. Not being a shill but there are so many points between care to receiving a remit that the breakdown could occur anywhere)
2. waiting until the 'fix' was in before getting someone paid

I always took care of things my way. My bosses always trusted me and kept my ability to release payments, LONG after moving out of the adjudication positions. Having a 500,000 override didn't hurt either. I can give lots of stories but, in short, for the place I cut my teeth... I always said I will never work for a place that let's bureaucracy get in the way of common sense or doing the right thing because it could be my mom on the other end of that claim. Not saying we didn't have issues and didn't screw up, but, the entire culture was an advocate for member first, then provider, then 'company'. People don't believe it, and those that do not like commercial carriers, either the group plans, private plans, or the MA plans, will never be convinced that those who get most upset with things are those who see the issues on the inside but can't fix it because.... list is too long to start. But carriers take it on the chin in the course of public debate, even when they aren't at fault.
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Old 02-22-2016, 04:01 PM
 
Location: Chesapeake Bay
6,048 posts, read 3,872,076 times
Reputation: 3502
Quote:
Originally Posted by Stymie13 View Post
I have heard that... mostly from providers (much of my work in healthcare was provider specific. Short story is making sure they got paid, even when we had the system jacked up). I didn't work for UHC (I have been recruited by them) so I won't say anything disparaging.

The industry is far, far from perfect. When faced with:

1. bureautic red tape in getting someone paid when there were issues (many times, it was provider billing errors, or clearinghouses. Not being a shill but there are so many points between care to receiving a remit that the breakdown could occur anywhere)
2. waiting until the 'fix' was in before getting someone paid

I always took care of things my way. My bosses always trusted me and kept my ability to release payments, LONG after moving out of the adjudication positions. Having a 500,000 override didn't hurt either. I can give lots of stories but, in short, for the place I cut my teeth... I always said I will never work for a place that let's bureaucracy get in the way of common sense or doing the right thing because it could be my mom on the other end of that claim. Not saying we didn't have issues and didn't screw up, but, the entire culture was an advocate for member first, then provider, then 'company'. People don't believe it, and those that do not like commercial carriers, either the group plans, private plans, or the MA plans, will never be convinced that those who get most upset with things are those who see the issues on the inside but can't fix it because.... list is too long to start. But carriers take it on the chin in the course of public debate, even when they aren't at fault.
UHC is at fault. A lot of times. They are well known for doing whatever they can to avoid making payments.

And in many parts of the country they have very high turnover rates in their Advantage plans. That in itself should tell you something.
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Old 02-22-2016, 04:09 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,929,938 times
Reputation: 6716
Quote:
Originally Posted by Stymie13 View Post
Some of the best consumer advice I've heard. And that is probably why your agent has been successful: for all the wonders of technology, personal touch still seals the deal, at least for everyone that grew up having to actually talk to people vs. being attached to their phone/twitter/facebook/instagram account.
It's not only the agent. It's checking things out in person. You can get good or bad vibes visiting places in person. I can't tell you that Mayo here is the best when it comes to everything in terms of all manner of health care. But it's certainly not a grungy place in a bad part of town. Which a lot of doctor's offices here are - especially those in Medicaid or Medicare Advantage networks.

I think that Kaiser Permanente works somewhat the same as Mayo in parts of California. A pleasant integrated health care home. Although I can't vouch for the overall quality of care there either. You can't always judge a book by its cover - but if the cover is substandard and dirty and worn and repulsive - the book is less likely to be one you might care to buy. Robyn
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Old 02-22-2016, 04:11 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,929,938 times
Reputation: 6716
Quote:
Originally Posted by Weichert View Post
UHC is at fault. A lot of times. They are well known for doing whatever they can to avoid making payments.

And in many parts of the country they have very high turnover rates in their Advantage plans. That in itself should tell you something.
OTOH - we have had no issues with UHC when it comes to Medigap plans.
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Old 02-22-2016, 04:22 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,929,938 times
Reputation: 6716
Quote:
Originally Posted by Weichert View Post
Thats all well and good. I guess.

However, if a person has done the research and decided that the MA plans are best for them, the next step is choosing the proper plan that best fits their needs. And that means skipping United Healthcare and any MA plans that they offer. Without exception.
When - if ever - would you advise someone to take a MA plan over a traditional Medigap plan - assuming money wasn't an issue? Robyn
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Old 02-22-2016, 04:37 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,929,938 times
Reputation: 6716
Quote:
Originally Posted by Stymie13 View Post
I have heard that... mostly from providers (much of my work in healthcare was provider specific. Short story is making sure they got paid, even when we had the system jacked up). I didn't work for UHC (I have been recruited by them) so I won't say anything disparaging.

The industry is far, far from perfect. When faced with:

1. bureautic red tape in getting someone paid when there were issues (many times, it was provider billing errors, or clearinghouses. Not being a shill but there are so many points between care to receiving a remit that the breakdown could occur anywhere)
2. waiting until the 'fix' was in before getting someone paid

I always took care of things my way. My bosses always trusted me and kept my ability to release payments, LONG after moving out of the adjudication positions. Having a 500,000 override didn't hurt either. I can give lots of stories but, in short, for the place I cut my teeth... I always said I will never work for a place that let's bureaucracy get in the way of common sense or doing the right thing because it could be my mom on the other end of that claim. Not saying we didn't have issues and didn't screw up, but, the entire culture was an advocate for member first, then provider, then 'company'. People don't believe it, and those that do not like commercial carriers, either the group plans, private plans, or the MA plans, will never be convinced that those who get most upset with things are those who see the issues on the inside but can't fix it because.... list is too long to start. But carriers take it on the chin in the course of public debate, even when they aren't at fault.
There are other issues too. Ranging from things Medicare won't reimburse all of the time. Like blood tests for things like Vitamin D deficiencies (got me why not - since many seniors - especially those of us who have had skin cancer and use sun screen - suffer from Vitamin D deficiencies). To things Medicare won't reimburse most of the time. Like removal of skin growths that might or might not be found to be cancerous except post-biopsy. When it comes to these things - I think a provider's expertise in terms of coding/knowledge of appeal processes - and willingness to do these things - is very important. My Doctor Plastic Surgeon's office is great when it comes to coding/appeal issues. More so than Mayo is. Which is why I'm a regular customer there for skin issues.

Overall - although I'm not a stupid person - I find the whole process very confusing. And I just try to understand things and roll with the punches. Robyn
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Old 02-22-2016, 04:48 PM
 
Location: louisville
4,754 posts, read 2,012,260 times
Reputation: 1713
Quote:
Originally Posted by Robyn55 View Post
When - if ever - would you advise someone to take a MA plan over a traditional Medigap plan - assuming money wasn't an issue? Robyn
Medical needs. Things like snf and inpatient stays have lifetimes 'days' of coverage, whereas ma plans, at least the ones my payor did underwriting on, don't. Also prescription drugs, geographic area, etc...

Since gap plans cover the 20%, and some of the experimentals, that may not be covered by traditional Medicare. That is one consideration. One also has to meet their deductible before the gap kicks in.

It's kind of a hard question because each state decides what policies are offered. If a and c are offered, all have to offer f... Best to look on med.gov and pull up the chart for a state.

Another factor is ma network vs deemed Medicare providers.

All in all, as the subsidies decrease for ma plans, the member cost share will go up. That's because the bids are based on 'pmpm' per member per month. And one has to take into account a sitting president and congress. Both use it as a wedge issue with one side more in alignment with traditional Medicare, one more in alignment with ma plans. Notice how enrollment switches depending on which party is on office... Behind the scenes that's due to subsidies and pmpm.

It is a mess, even to those on the inside.
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Old 02-22-2016, 04:51 PM
 
Location: Living rent free in your head
31,060 posts, read 13,591,379 times
Reputation: 22129
Quote:
Originally Posted by Robyn55 View Post
There are other issues too. Ranging from things Medicare won't reimburse all of the time. Like blood tests for things like Vitamin D deficiencies (got me why not - since many seniors - especially those of us who have had skin cancer and use sun screen - suffer from Vitamin D deficiencies). To things Medicare won't reimburse most of the time. Like removal of skin growths that might or might not be found to be cancerous except post-biopsy. When it comes to these things - I think a provider's expertise in terms of coding/knowledge of appeal processes - and willingness to do these things - is very important. My Doctor Plastic Surgeon's office is great when it comes to coding/appeal issues. More so than Mayo is. Which is why I'm a regular customer there for skin issues.

Overall - although I'm not a stupid person - I find the whole process very confusing. And I just try to understand things and roll with the punches. Robyn
I guess I'm lucky, both my Vitamin D test and two visits to a dermatologist to remove skin growths were covered without question. In fact I never had any service denied, that was with my Anthem PPO medicare supplement. I'm healthy but have a somewhat unusual condition, Raynaud's disease and I had multiple referrals to specialists, and I never heard a peep from Anthem, they just paid the bills that were left after Medicare paid. I would have probably stayed with them but their rate went up to $380 a month and my employer supplement is $300 so I jumped ship and went to Kaiser, but in retrospect I'm glad I did, I really like Kaiser.
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Old 02-22-2016, 04:52 PM
 
Location: louisville
4,754 posts, read 2,012,260 times
Reputation: 1713
Quote:
Originally Posted by Robyn55 View Post
There are other issues too. Ranging from things Medicare won't reimburse all of the time. Like blood tests for things like Vitamin D deficiencies (got me why not - since many seniors - especially those of us who have had skin cancer and use sun screen - suffer from Vitamin D deficiencies). To things Medicare won't reimburse most of the time. Like removal of skin growths that might or might not be found to be cancerous except post-biopsy. When it comes to these things - I think a provider's expertise in terms of coding/knowledge of appeal processes - and willingness to do these things - is very important. My Doctor Plastic Surgeon's office is great when it comes to coding/appeal issues. More so than Mayo is. Which is why I'm a regular customer there for skin issues.

Overall - although I'm not a stupid person - I find the whole process very confusing. And I just try to understand things and roll with the punches. Robyn
The worst part of what gets reimbursed? The AMA has the contract and they assign a payment indicator or status indicator to each cpt code. All of that is public on cmms.gov but it does take some familiarity to 'get it'.

Hearing devices is another. Dme services... The lists of what is vs what isn't does always pass the common sense.
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Old 02-22-2016, 04:53 PM
 
Location: Chesapeake Bay
6,048 posts, read 3,872,076 times
Reputation: 3502
Quote:
Originally Posted by Robyn55 View Post
When - if ever - would you advise someone to take a MA plan over a traditional Medigap plan - assuming money wasn't an issue? Robyn
There are a few, especially if you live in an area with 40%-50% (or more) of all Medicare eligible are enrolled in Advantage plans AND a major hospital (like Mayo) or medical school (and their associated facilities) are in the plan networks. And they are highly rated.

But I think generally the high deduct plan F is the best deal going.
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