Aren’t the doctors you choose required to be part of their Preferred Provider list?
+1
Additionally, I haven’t yet been in a situation where a doctor wasn’t on the “approved” in-network list. When they switched us to Aetna Medicare Advantage, the first thing I did was to check whether all of my doctors at that time (5, in all) were on that in-network list, and they all were.
Since that time, I’ve added two more MDs, and they were both also on the in-network list, which means a $10 co-pay, with no additional charges from them. Of course, just as with “regular” Medicare, my annual physical exam is free, as are the vaccines that I need.
Well someone has to do all the work for all the people with tender hands that can’t change a tire.
You’re a special case: NJ state has a lot more swing than an individual. People less fortunate, with no one but themselves to look out for them, insurers can give short shrift. 30 years ago, when I had a beef with BC and they stonewalled me, I took it to HR at my employer, who straightened it out.
There used to be a US Route 666 in western New Mexico, eastern Arizona. They changed the number.
I’ve had an incident in each of the last 2 years that sent me to the hospital to get immediate surgery. I stayed 4 days each time. Each time the hospital billed over $100K; the insurer paid about $20K; I paid $1500.
Not everyone has the energy, especially people who live alone, especially old people who are failing. NPR used to have a ‘bill of the month’ series: listeners would send in their suspicious bills, NPR had a physician who used to work as an insurance adjuster investigate. Almost always they rolled over. What happened to the hundreds whose bills NPR didn’t investigate?
I do too. I haven’t had anything that required preauth, but the plan docs require it for some care. I’ve been referred to physicians who aren’t on my PPL.
I don’t remember the exact amounts anymore but I’m sure my hernia surgery was around $6000 total. I paid under $200 total. I kept waiting for another bill to come. Maybe the difference between New Jersey and rural Minnesota.
There will always be those falling through the cracks and needing extra help no matter what system is in place. The exceptioms do not define the results.
Read up on Canada’s or the Brit NIH systems and their failings. Look to our own Medicare system parts A and B. They are as screwed up and wrought with fraud as any of them.
No. I can choose any doctor I want. If I choose an out of plan provider it costs me more. Fortunately my Medicare Advantage is associated with one of the best hospital systems in the world. My GP and GI doctors are in a different system, but they are on the preferred provider list. My dentist isn’t on the list because my MA pays dentists so poorly. Very few dentists are in the program. He gets paid some from my MA and I pay the rest. I’ve used him for about 40 years and my wife even longer.
There is no extra help in the US. I cited 2 articles from the medical literature: JAMA and the Annals of internal medicine. I can cite more. Healthy people and people who can lobby on their on behalf, or have someone who can, can get what you say. Others die for lack of care. I have read about the problems in UK and Canada: everyone suffers some, not just the unwealthy. They pay half what we do, live longer and more healthily. MA patients cost the taxpayer more, not because they get better care but because insurance companies know how to play the game.
2 Likes
Sure there is. There are agencies for the elderly in every state. And if you don’t like the Medicare Advantange you can just stay with parts A and B or buy a supplimental plan. No pre authorizations required.
Since they are paid what Medicare would use for you, they cannot cost more. There is no more.
This thread started with me saying the system is broken. I also said I believe a nationalized health care system is needed because our current system is un-fixable. I agree things are a mess.
I originally replied to answer Bings question where the money for advantage plans comes from and how and why people use them.
This discussion is over.
If you switch you get underwritten for the supplemental plan, which can charge anything it likes. And they can refuse to pay for care.
They can get bonuses - want docs?
From ‘The Opportunity Costs of Medicare Advantage Plan Rebates’, https://www.nejm.org/doi/full/10.1056/NEJMp2405572 :
‘When establishing the private-plan option for Medicare beneficiaries, policymakers intended the program to be more efficient and less expensive than traditional Medicare. Today, the bids of private Medicare Advantage plans are almost always lower than payment benchmarks. Yet the way in which Medicare pays these plans leads to the federal government spending more on Medicare Advantage than traditional Medicare and to higher premiums and cost sharing for beneficiaries in traditional Medicare. When a Medicare Advantage plan’s bid falls below the benchmark, the federal government pays the plan not only the bid, but also a rebate – which is equal to at least 50% of the difference between the bid and the benchmark. To illustrate the consequences of continuing to use current methods of paying Medicare Advantage plans, we compared data on Medicare Advantage rebates with the projected cost of providing enhanced benefits to all Medicare beneficiaries. The list of benefits that could be provided to all beneficiaries demonstrates the opportunity cost of using rebates to fund extra benefits for only Medicare Advantage enrollees.‘Despite low Medicare Advantage bids, federal payments to plans are higher than the amount it would cost to cover similar people under traditional Medicare.’
About 4 years ago, I developed a sudden weakness in my left hand. My local doctors ruled-out a stroke and they attributed it to Arthritis. So, I decided to self-refer myself to the top-rated Rheumatologist from University of Pennsylvania Medical Center, in Philly. Fortunately, she comes to Princeton Medical Center once each week, so I didn’t have to travel more than 20 minutes to see her.
After extensive testing, she determined that the cause was not Arthritis, but actually some sort of virus that had localized itself in my hand. After a few weeks of treatment with an antiviral drug, the problem went away.
Anyway, that renowned U of P Rheumatologist was “in-network”, and my co-pay for her treatment was $10.
Medicare Advantage might be efficient sometimes, but not always. I retired at 70 and had private insurance until then. I applied for Medicare D, but it wasn’t granted to me until 2 months past my retirement date. At first, they wanted me to pay a monthly penalty for not obtaining part D earlier. I eventually convinced them that I applied for part D properly and they lowered my payment to $0.00. I still get a monthly notification by mail that my $0.00 premium is due, including an envelope for my remittance. I file the paper and recycle both envelopes. I’m sure this will continue until I die. If MA does silly stuff like this, how many other ways are they wasting my Medicare dollars?
I worked for a federal agency for six years. The lower level employees that are aware of such unnecessary expenses can do nothing. I tried, the response “it is not your job to make recommendations, that is management’s job”.
There’s a medicine cliché: when you hear hoofbeats, think horses, not zebras. You had a zebra. It was lucky an antiviral worked.
MA isn’t the problem: it’s Medicare that requires retroactive premiums for signing up late. Otherwise people would delay until they needed expensive medications. I didn’t sign up for D in the beginning but all available plans eventually included it so I have to pay the extra premium. Last year I got my first covered medication: 98¢. Not only did I get a bill, I got a quarterly summary of my activity for the drug benefit. I have a $500 deductible, so I was 98¢ into it. 3 weeks later BC sent me a letter telling me the hospital pharmacy was no longer a preferred provider, recommended I switch. Another 3 weeks later they sent me another letter telling me it was back on the PP list - all for 98¢.
I’ve tried to correct errors in the billing systems at a local hospital and my insurers. It was a waste of my time. When you consider the cost of labor to straighten out the problem it may be cheaper just to let it ride.
I know that and it’s not my complaint. Sending me a letter and return envelope monthly forever to tell me I don’t owe anything is unnecessariy and expensive. Expensive? I’m sure that I’m not the only person in this situation. There are 65,636,490 Americans on Medicare. If only 1% of them are in a similar situation, then 656,365 people receive worthless mail. If it costs $2 per month each, then it costs almost $16,000,000 each year.
1 Like
Not to change the subject to credit cards but you said they sent you a notice that you owe nothing. I got a statement from my Gm card, now run by Marcus, with all zeros. No balance, no payment due, etc.
I used my card for a car rental in February. I waited to get a bill but none came. Finally I called and said the bill was mailed. I just did the payment over the phone. No bill came until the 25th with a due date of the 20th. Glad I paid it. Then yesterday got the new statement with zeros. I know the government has a lot of problems but large corporations seem to also have some issues. I hadn’t used the card for years so we’ll see what comes next month.
Similarly, I only use my LL Bean credit card a couple of times each year, but I get bills with a zero balance in the months when I haven’t used it.
You could use the credit card and then there would be a nonzero balance. It is also possible that a thief could use your card and getting a monthly recap helps you see that ASAP. In my case, it was a once and done dispute resolved when they told me to that I didn’t owe anything. That balance is never going to change. If they hadn’t made the error to begin with, I wouldn’t get the billing statement asking to return the zero balance remittance.
You get what you pay for. A lot of the Medicare Advantage complaints are with plans with zero dollar premiums. Some plans even pay YOU. Guess which plans then get complaints.
The good plans (which carry a premium) have a good reputation.
1 Like
I get a bill from Xfinity every month saying I owe them $0. Our condo building includes cable in our assessments yet we still get the bills for zero. It’s computer systems with no human oversight.
1 Like