New to medicare, being denied cataract surgery

self

[eastexsteve]

“The vast majority of non-pediatric primary care physicians (93 percent) say they accept Medicare—comparable to the share accepting private insurance (94 percent).”

My primary care doctor will only accept new medicare patients up to a certain point of the year.

[Sequoyah101]

MA is a crock.

[Kirkwood]

1) Find another eye surgeon. There are tons of them in FL
2) Pay for it out of pocket. You can negotiate if insurance is off the table.
3) The doc that denied it is an idiot because you now have unequal vision, making surgery a necessity. Be glad he denied it so you have the chance to get someone who knows what they are doing.

[Notthereyet]

“Plan G is the Cadillac of supplements.”
_________________________________

I’d have to pull the pamphlets out of the bin where I store them to refresh my mind, though I believe we have the Plan G for my beloved husband.

When he hit the age for Medicare I read everything I could and got supplements on everything I could think of, except for dental. Our agent was stunned I had read so much before hand and had all my questions written in order by subject. My beloved was really hesitant about the dental, figuring we could handle it and it proved to be a minor mistake as far as I’m concerned. That said, we have the funds for the work needing to be done for unexpected work and are grateful.

I retired from a Frontier and let me tell you, there was no way I was going to have him on their Over65 plan or whatever it’s called. No way, whatsoever.

The Medicare process for him is a warm-up for mine, I figure. I’m thankful I don’t hit 65 until towards the end of 2021. LOL

So far, the Plan we have for him has worked out very well. :)

[catnipman]

“Anyone else with any suggestions or similar situation, please share.”

yep. never sign up for medicare disadvanage ... sign up for straight medicare with a Plan F or Plan G supplement and go to nearly any damn doctor in the country that you want to ... like all else, you get what you pay for ...

[DannyTN]

Unless they have changed, the Medicare advantage plans are legally required to provide everything that Medicare does.

File a grievance with Medicare. The company will have to respond to Medicare. The last thing a Medicare Advantage plan company wants is an investigation from Medicare. And they will usually jump through hoops to quickly address any grievance claims.

[WASCWatch]

You need to get a Medicare Plan G supplement. It will cover what you need, but you need to get it NOW Mutual of Omaha is good, and so is a plan through AMAC, the conservative alternative to AARP.

I had cataract surgery on one eye last year. More eye doctors will write off your Medicare co-pay. If you want the next level upgrade, it’s about $900 more; and worth it if you can afford it.

[TennesseeGirl]

"yep. never sign up for medicare disadvanage ... sign up for straight medicare with a Plan F or Plan G supplement and go to nearly any damn doctor in the country that you want to ... like all else, you get what you pay for ...

I wondered about that. Thanks for you're input. I'm not there yet, but I remember an elderly woman at church told me YEARS ago that she found she liked the regular, standard Medicare and then paid for a Medicare supplement and she was happy with her coverage. Her supplement might have been through Farm Bureau or AAA or something like that. She said the same thing...she went to the doctors and hospitals of HER choice, not some bureacratic M.D. or nurse practitioner who sits in a corporate insurance company building and hadn't seen patients in years!

[catnipman]

a few additional points:

1. you should also have a supplemental plan to pay for hat basic medicare doesn’t pay for, which will be very substantial for a major illness. the supplemental plans are all standardized, so the cheapest one in a given category is the best as there’s no difference

2. Plan F and Plan G are the most comprehensive, essentially paying for everything not paid for by basic medicare (part A and Part B) ... Plan F is no longer offered for people born after a certain date, but Plan G is almost the same

3. In my state(and some others), the cheapest Plan F (and i assume Plan G) is AARP’s deal with United Health Care ... you have to join AARP, but it’s worth it to get their deal with United Health Care

4. The real bitch kitty is drug coverage when you don’t do medicare disadvantage, because you’ll also have to select and pay for a Plan D, which is a real nightmare (thank you very much, George Bush, you piece of shit), because there’s different formularies(list of covered drugs), tiers (different cost levels for different drug categories), amount of deductible, and the “doughnut hole” (a gap in the middle of maximum total payout that’s not covered)

here’s the best link i’ve found for comparing Plan D’s:

https://q1medicare.com/PartD-SearchPDPMedicare-2020PlanFinder.php?state=CO&utm_source=partd&utm_medium=enrollRegChart&utm_campaign=link2otherpdps

[catnipman]

this post i made to TennesseeGirl might be useful to you as well:

https://www.freerepublic.com/focus/chat/3850888/posts?page=29#29