Posted on 02/06/2024 4:57:01 AM PST by tired&retired
How can Humana change the coverage after the patient is admitted?
I logged into the indiviual account and printed the "My Benefits" in November when a close friend was hospitalized for a severe stroke. I have full medical and legal POA.
The "Plan Benefits" showed FULL PAYMENT Coverage for skilled nursing through day 100.
While she was admitted, they changed her plan to only cover 80% through day 100. With a $203 per day co-pay, that is a lot of money she doesn't have.
How can they change the plan during continuous admission?
In addition, they keep denying any payment saying she is not benefitting from the treatment. She clearly is benefitting based upon a team of medical specialists who ordered rehabilitation treatment and are evaluating her on a regular basis.
Five times now they denied coverage five times I appealed and won. They are doing this to everyone. United Healthcare is doing the same.
This week, I won the appeal on Saturday and Monday they denied payment again.
I feel bad for all the senior citizens who have lived one's in treatment and must fight for coverage. Humana is ripping off many people and Medicaid by forcing people out of coverage.
In this case, she must give up her home for rehab, thus she has no place to live after she improves and no longer needs care.
If she were an illegal immigrant, all this would be paid by the government.
Any advice is welcome as my blood is boiling, I'm that angry at the Medicare Advantage rip-off plans.
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I’m interested in any thoughts on Medicare Advantage plans vs. straight Medicare Supplement plans. Currently in the sign up process.
Just switched from Humana, but you are right. They are all pretty much the same in denying benefits..My advice is NEVER pay until you get an actual EOB. It usually takes at least two months. And when they call (and they do continuously), just tell them you won’t pay until you get your EOB.
I have humana Medicare advantage plan for 6 years. I am very happy with it.
For us slower members of the class, what’s an EOB?
Think that’s bad, I’m 63 so two years away from Medicare and I have to pay for Obamacare for me and my stb 56 yr old husband. We’ve tried healthsharing plans and wasn’t much better than Ocare.
Premiums are more than my mortgage payment. While I was still working my W2 job that I retired from back in Nov. 2022, (highly stressful; ran systems for 911 center of good sized county)
Had stage 1 breast cancer back in 2021 and I just told my doctor for that I will not be getting a dexta scan, etc. as every time I pay for stuff out of pocket with my HSA, before I meet the massive deductible, it never seems to clock down!
Nothing puts a dent in the deductible so I’m basically paying for catastrophic hospitalization but at a MUCH higher cost than it used to cost back before Ocare.
Explanation of Benefits
Prayers up for your friend.
Canât offer help on health insurance, just my disgust and stack of bills.
As a Humana customer I can say with no reservation that Humana Advantage is excellent coverage. Nefarious complaints to the contrary, Humana ia as good as it comes.
My mother has been in an Advantage plan for years. We just moved her to a supplemental because of the crap care her Advantage offers.
I can’t speak for other places, but NYS is investigating Advantage plans and how the elderly are being scammed. They take your entire Medicare allotment and then deny services.
We called the AMAC people and got good advice when we turned 65. That might be a good place just to start gathering info.
I signed up for standard Medicare a few months ago.
I’m sort of like a fish, I like to swim in a large school.
I finally signed up for a Medicare Part D plan. I take no prescription drugs, but I entered in a few glaucoma drugs and a drug I remember from TV ads on the Medicare Part D website (which is nicely done). The prices of the drugs was shocking. If I had to take them, they’d cost from $5500 to $13000 per year. I found the Wellcare $0 premium plan had the lowest fixed cost and might only cost about $100 more annually if I needed drugs given its higher deductible.
Humana .. owned by United Health Care.đ
Whatâs on an explanation of benefits?
General information about you and your health plan
The explanation of benefits includes information about:
You (the patient)
Your health plan
Who provided your care, and when it was provided
A reference number called the claim number
The person who gets reimbursed for any overpayments, called the payee
It will also list your health planâs phone number. Call your health plan if you have questions about finding a provider or what services they cover.
Details about your claim(s)
The explanation of benefits gives you details about your care, like:
The date of service
A service description. This explains what service you had, like a medical visit, lab test, or screening.
Information about your bill
The explanation of benefits lists the cost of your care, and how much your health insurance company will pay.
âProvider Chargesâ is the amount your provider bills for your visit.
âAllowed Chargesâ is the amount your provider will be paid. This may not be the same as the Provider Charges.
âPaid by Insurerâ is the amount your health plan will pay to your provider.
What you owe
What You Owe, or Patient Balance, is the amount you owe after your insurer has paid everything else.
You may have already paid for part of the Patient Balance. The Explanation of Benefits only shows what you owe, not if youâve already paid for it.
Your bill should not be higher than the Patient Balance. If it is, talk to your provider.
Remark code
A remark code is a note from the health plan that explains more about the costs, charges, and paid amounts for your visit.
The code is usually 2 or 3 letters and numbers. Check the bottom of the explanation of benefits for a description of each code.
https://www.cms.gov/medical-bill-rights/help/guides/explanation-of-benefits
It might be possible for her to live with a relative who no longer works.
Understand that custodial nursing care is legally considered different than rehabilitative nursing care.
Explanation of Benefits. The hospital/Doctor’s office will send you a bill right after your procedure/Dr. Visit, where the Insurance has not been approved (yet), so it appears that the Insurance has been denied. The EOB lists each charge, and how much the Medical paid, How much the Insurance paid, and how much you are charged. Many times we have seen the actual coding number has been the wrong number, which means that it won’t be paid. Unfortunately, you are the one who has to make sure they have the correct code for each entity. How many old people (like me) have just paid the initial bill and trusting the billers is probably staggering. The Medicals are glad to get paid regardless of who pays it, you or insurance. The con is that they charge enormous costs for each event, and then the Insurance company denies most of it, which the medical folks write off. If you did not have insurance, you would be responsible for all of the original bill. For instance, last year my gross medical costs were in the millions, but insurance denied most of it, and I paid what remained, which remained several thousand dollars, but not the millions that were written off.
In some states Medicaid might be helpful but her estate will probably have to repay Medicaid if the care is custodial.
prayers for your friend.
I think they started over with the new year - new deductible, etc.
I recently went thru the denial of claim issue with a friend who is now deceased. Hospital sorta forced him onto hospice due to a swallowing issue. (no nursing home would take him without it - 2 years ago, I could sign a waiver for him to eat regular food.) With him being on hospice, he got NO physical therapy even though he wanted it. He was condemned to a wheel chair...
on the denials - make sure of the dates and make sure the hospital updates the dates continually as long as they think your friend is improving. Humana will decide to save money....
Check the Medicare guidelines. If the proceedure is covered 100% by Medicare, then the Medicare advantage/replacement plans are also required to cover the same proceedure 100%. To do this you’ll need to obtain the proceedure code and then cross check it with the list of covered proceedures as per the Medicare guidelines.
Right there with you. in the last ten years, my gross cost was in the millions, but with insurance, I had still had to pay tens of thousands of dollars. I think they are trying to ‘squeeze’ the last blood out of us old turnips before we ‘toddle on’. Our insurance was over $2000 per month until we started getting medicare. Now they still get about 40% of our Social Security, but leave a few dollars for us to live on.
I also have Humana Advantage plan & am very happy with it. I had a bicycle accident with over $150,000 in bills, I paid about $1000 out of pocket because the ambulance was out of plan.
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