Posted on 11/24/2023 10:47:42 AM PST by buckalfa
“The Medicare Supplement products are NOT cheap.”
It depends. Like I just said my Part F premium is just over $110/month.
That’s so that the nonprofit hospitals can write off Z90% of care as a “loss” for tax purposes.
My mother in law had mma Humana South Florida
I handled her claims never an issue
There were plenty of claims!!!
https://www.propublica.org/article/health-insurance-denials-breaking-state-laws
Claim File Helper
https://projects.propublica.org/claimfile/
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
But you have to admit that the core of medicine has made a valiant effort to cash in, too. Why does an audiologist charge ten times what a drugstore does for essentially the same hearing aids?
Every po-dunk town used to have an eye doctor who made a fat living working 4 short days and playing golf on Wednesdays until somebody figured out eyeglasses didn't have to cost an arm and a leg.
And the duplication of million dollar diagnostic machines in service areas is another cost-driving force. We have a good friend wh is a Doc in private practice, and he loves to talk about the two medical monstrosities at war in our service area, but they do everything but fight a price war.
I’m pretty sure the formularies (covered drugs in different categories) vary among Part D plans but have to verify that. When I picked my Part D plan three years ago I thought that my selected plan was better for high-tier drugs but again have to confirm. I seem to recall that all Part D plans have to cover a given number of drugs in each category but which ones and maybe copay amounts is up to them.
I swear to God that no one really knows everything until a claim is filed.
iirc, I think I read something recently about proposed legislation would make buying prescriptions from Canadian pharmaceutical operations illegal for US citizens.
Any chance this could happen?
Yeah, but they don’t have discretion to deny a Part D claim if the drug is listed on the formulary. It is either covered or it isn’t.
Any chance this could happen?
I think it is illegal, but not seriously enforced. I really don't know enough to have a strong opinion. If Canadian taxpayers subsidize the price, that is not fair. I can't see why some US sellers do not have a process to bid on the meds, so there is competition. Big Pharma does seem to have license to steal. It is probably just another example of corruption, sad to say.
Sounds good, but the dosage or the need may be argued.
My broker also refuses to sell Medicare Advantage.
From quick reading it appears that a denial can come only from 1) Need to use less expensive drugs first (step therapy) - which is clearly documented in the contract or 2) Because the plan covers only 30 per month, etc., and not more, or 3) Because prior authorization wasn’t obtained for certain drugs (this is the area where they may have some discretion — it isn’t a factor for common drugs).
bookmark
They are out there! Use an agent/broker who you can contact after the dotted line is signed. Do not buy on the internet. MHO
Regarding insurance in general, claim denials are very often in error, though, and never in the policyholder’s favor. A certain amount of people will just pay, right or wrong, out of frustration with the bureaucracy.
you’re lucky, F nolonger exists...
Thanks. I am dreading the research- it’s so confusing. I don’t really have any peers to ask and have no idea where to find someone knowledgeable and reliable who isn’t a sales person. I just wish they’d give us the $ instead in something like the form of an HSA type card so I could continue to do WTF I want, when and where I want. I don’t even know if I’m on my husband’s plan if I still have to apply yet or not!! This is a PIA
One thing I forgot to mention, I am also receiving Entyvio infusions (had 3 so far), and I have not had to pay a penny for those, Thank God.
Yes, it is an enormous PITA. The reason I decided on the Part G supplement was that I could always change to an Advantage plan later, but it’s not always possible to do the reverse, as another poster commented earlier.
You might be able to talk to someone at Medicare, too, not just insurance agents. Good luck.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.