Posted on 02/06/2024 4:57:01 AM PST by tired&retired
Welcome back!
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There are more than one insurance companies out there that ROUTINELY deny claims, procedures, efficacy, etc. They do it because most times they can get away with it.
What you should do is start keeping track of and itemizing the denials and time line and then call your state insurance commissioners office and talk (really) talk to one of his aides if you can. Lay it all out and then follow up with the evidence. A state insurance commissioner is about the only thing a health insurer (or other, for that matter) cares about because he has to power to decredit them.
Medicare is a level of complexity that you WILL NOT UNDERSTAND.
Find a certified agent. They deal with the details every single day. They will know things you will never know.
There is zero reason to believe Advantage is a scam. About 40% of new 65 yr olds choose Advantage plans and that number is growing. They have items of superiority. They have items of inferiority and a certified agent can lead you through all this.
As for what happens after you have the selection made, no plan scams you any more than any other plan. They all will try to scam you.
When Medicare was put into place, limiting it to 80% created the entire Medigap/Advantage industry and it’s absurd. It should have provided 100% coverage. If that meant payroll withdraw was higher, then so be it. Better that than this insanity we deal with now.
That's what sold us on original Medicare with Medicare supplement. We don't want to worry if the emergency room personnel are in our network.
We LIKE out advantage program. After decades with only one use of insurance, it’s fantastic to get included dental, vision, annual exams, urgent care, health clubs, and more for no extra cost. Last year I got an iWatch (wearable fitness device) for $12.
I’ve never heard anyone support Supplement programs other than my brother whose retirement pays for it. If money’s no object and you anticipate bring sick because of poor lifestyle and dietary choices, then maybe they make economic and risk management sense. We would rather spend about $350/year each on nutritional supplements, eat very healthy food, and exercise regularly, with a no-cost advantage program.
Too late. We live in New York State where only productive citizens pay through the nose for health care.
I personally have a Fed VP Blue Cross/Blue Shield for life and Medicare.
I travel the world and Medicare is not for out of the country. So my BXBS plan is the same one the diplomats have in the foreign embassies. I once had to show that I had $100K in coverage to travel in a foreign country and asked them for a certificate. They laughed at me and said it is unlimited, thanks to the Department of Defense.
I have two friends who just moved here from Cuba. Young and hard working couple, but what a surprise as their food, housing and medical care was free there, just wait in line.
The claims processor gets paid per claim processed. Every claim has to be entered into the system. If the claim is denied and then paid they get paid twice as much for the same amount of work.
You get what you pay for.
Thank You!
Mixed public-private partnerships can go wrong in a lot of ways.
This is one of the ways.
Forget Humana. Involve your 2 Senators and your congressman. Medicare “Advantage” is probably generating huge bribes to prevent regulation, Medicare at the end of the day is a Federal health care program, legislators will be terrified of ending the gravy train, and a shove from them in the right place will fix your immediate problem.
I will have to choose at some point, I’m way past age but still working.
Based on everything I have seen during my medical career, I favor conventional Medicare. There are too many ways for MA contractors to scam the system at the patient’s expense.
Heavily leaning that way at this time. Thanks.
Sorry to hear that........
Just another reason we left.
Like I think I may have said somewhere above, certainly have in this process - the Advantage plans having “no/zero up front cost” makes the hairs on the back of my neck stand up.
Look at it this way.
There is a large pool of money - trillions - contributed by employers and various levels of government to pay for the care of the sick. A piece of this pool is set aside for the care of people > 65.
Until recently, Medicare administration of the >65 pool was very cheap as a percentage of charges - much cheaper, more efficient if you will, than “private insurance” (which is neither private nor insurance). But the ability of Aetna and Humana, etc, to skim off the top of the employer contribution pools hasn’t caused a problem, because employers can raise prices, etc, and they actually don’t mind the skim for reasons too complicated to go into here.
But letting the money skimmers into the Medicare pool was a big mistake. Medicare is a BENEFIT PROGRAM for people >65. I am now 73, still employed and insured that way, and a lot of Medicare users are much older than I. Looking at the deluge of ads I get every “enrollment season” since 2015, I can’t imagine the majority of Medicare users are making wise choices if the go the MA route.
Let me tell you, if you don’t already know, it gets easier to throw a fastball by you when you pass 70, and more so when you are >80. It is wrong, and it allows what amounts to theft of personal contributions and taxpayer money to allow these Medicare “Advantage” plans to function as they do.
And, on a different note, for people here who don’t understand why there is a large group of voters who hate Republicans as much as they do, Medicare Advantage could well be exhibit #1.
Congratulations on your excellent self-care and wisdom in product selection.
I've been a doctor for 50 years come July 1, and if you know the story of the Tower of Siloam and Matthew 5 then you know tragedy is unpredictable and that the rain falls equally on the just and the unjust.
Medicare has made it possible for people >65 to have care they never could have paid for before. But the real costs are the >75 and even the >85. They are paying against future expenses in the $100K - $250K and up range. The older old don't care about health clubs and all that other marketing crap the MA plans use to "thin the herd", so they get payment that average out over all ages but get customers, typically 65-72 or so, for whom the health club benefit has meaning and a shattered pelvis in a car accident is inconceivable.
Truth will set you Free: You are correct about Part D. However most Advantage Programs do include Part D coverage. I find it risky not to have it (although their formularies, just like Medicare supplement part D coverages) as the unknown illnesses and meds like chemo etc are too expensive for me to handle on my own. The tier system of co-pays for meds costs me quite a bit as I have 2 tier 4 meds. Still though, having Part D for me makes sense.
My parents are both 92 and get around well. My dad is on a MA program and only has one of two prescriptions. My mom takes a handful though. I’ve heard moving is important for the elderly, and while my dad doesn’t golf (pulled his own bag) or play tennis like he did a few years back, he’s still consistently walking 30 minutes a day.
Mentioning “shattered pelvis in a car accident is inconceivable” is a bit ironic. At the end of October a slower moving car making a left turn hit me while I was crossing at a crosswalk. Fortunately I had no broken bones and knew what to from a previous knee injury.
“there is a once in a lifetime window that lasts for 6 months after you get your part “B” Medicare (or your 65th birthday for most folks) in which you do not have to have underwriting.” - If I keep working & having employer-sponsored health insurance past age 65 does that push my window out to the date my employer coverage ends? Thank you in advance.
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