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Conversationalist
Posts: 11
Registered: ‎07-28-2009

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Message 1 of 89 (512 Views)

There was a misunderstanding posted in a comment here.  Doctors DO NOT have to take Medicare.  If they take it, they also have to take a Medicare Supplement.  They do NOT have to take a Medicare Advantage. 

Valued Social Butterfly
Posts: 22,426
Registered: ‎03-04-2009

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Message 2 of 89 (567 Views)

Gail  thank you for your response.
I wish that I had know more about Medicare and Medigap  than I even know today, I would have fought with the Dr.s  for not actually providing me with a Pre Diabetis diet mainly because my Diabetis 2 is and has always been extremely contained and very mild. Instead they put me inmediately on pills, creating a pre condition that has  had implications in the future. 
I wish that I had know about the injections for my Macular Degeneration and what they ask you in any questionair plan which is  if you actually receive injections.  and I would have probably delayed the process or applied for a supplemental before the diagnosis was made.
There are lots of things that due to ignorance that I have done, have had consequences probably my fault.
I do fully understand what you are saying about the doctors, I still think that they are also gaming the system in their favor and not in favor of the patients. Because they do want those supplementals and they have to accept the original Medicare patients. 
I guess that is life and the system that we have in the US.  more than ever, I feel that we really need a National Health Care system. too many things are done these days that are not right or fair.

 

Valued Social Butterfly
Posts: 8,793
Registered: ‎08-18-2008

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

[ Edited ]
Message 3 of 89 (625 Views)

rker321 wrote:

Hey guys,  as a Medicare Advantage PPO recipient. I can choose to go out of network but before I do. I have to contact that doctor and ask if they are willing to bill my Medicare Advantage insurance. and of course  pay a lot more money for my co payment.
Having said that, when I just changed insurances, I made sure that I contacted the doctors that I knew were out of network to see if they would bill my Medicare Advantage plan, and they do. otherwise I would have had to choose another insurance carrier.

Having said that, I think it really sucks that If I choose a doctor out of network and they don't want to deal with my Medicare Advantage plan, and they already accept medicare patients, that they should be able to bill Medicare directly for the services that I incur. But apparently, it doesn't work that way, But, I have the intention to put a complain to Medicare  and see  what happens.

 

 


Medicare.gov - Your Medicare Coverage Choices

 

You pick either Original Medicare or Medicare Advantage - once picked that is your way of getting your Medicare benefits.  Between the two choices, everything is different - the amount they pay the provider, your copays, your coinsurance.  They do not co-mingle.

 

Medicare and You - video on Understanding Your Medicare Choices

 

In your previous post you said - I am just answering here for convenience. 

rker321 wrote:

If they are not health insurances those companies, what in the heck are they.? I am really not sure that I want to go to a simple medicare patient. I have always had the feeling that Medicare only patients are somewhat discriminated by the doctors themselves. is just a feeling, besides, Medicare only pays 80% of the bill and at least the other Insurances to cover more costs than the 80% and the drug prices are a lot better than if I just got a stand alone prescription drug  program. I don't have the advantage of negotiating like they do.

 

Supplemental Medicare Insurance is supplemental insurance, it is not health insurance; simply,  it only picks up what the main insurance does not pay.  It ONLY works with original Medicare NOT Medicare Advantage plans.  Compare it to perhaps gap insurance in the auto insurance industry.  Gap insurance, more accurately called gap protection, covers the difference between what you owe on your car and how much the car is worth.

Su

 

Medicare.gov - What is Medicare Supplemental Insurance (Medigap)

 

Look, rker321, I am sorry that your out of network doc has put you in this situation.  The dispute is actually between this doc and your Medicare Advantage PPO insurer - you are just collateral damage.  I can understand your problem but there is little you can do about it - However, you do have choices - Pick another Medicare Advantage plan, PPO, if that is your need, in your area where your docs are either in network or if it is a PPO, that they will work with you within the PPO as out of network.

 

You could change your choice of how you get your Medicare benefit from Medicare Advantage to Original Medicare but that will probably be either without supplemental coverage or a very expensive supplemental plan if an insurer decides to underwrite you.

 

I understand your fight here but honestly because a doc does have the right to pick his patients in this regards - limit in number or limit by insurer - I just don't know how this could be fixed.  Whatever excuse they give, it works out the same because original Medicare and Medicare Advantage plans are Medicare - just different ways of getting your benefits just in different ways.

 

Sounds like you have already made your decision - Hope this MA plan works better for you.

 

Good Luck -

 

 

Valued Social Butterfly
Posts: 22,426
Registered: ‎03-04-2009

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Message 4 of 89 (635 Views)

Hey guys,  as a Medicare Advantage PPO recipient. I can choose to go out of network but before I do. I have to contact that doctor and ask if they are willing to bill my Medicare Advantage insurance. and of course  pay a lot more money for my co payment.
Having said that, when I just changed insurances, I made sure that I contacted the doctors that I knew were out of network to see if they would bill my Medicare Advantage plan, and they do. otherwise I would have had to choose another insurance carrier.

Having said that, I think it really sucks that If I choose a doctor out of network and they don't want to deal with my Medicare Advantage plan, and they already accept medicare patients, that they should be able to bill Medicare directly for the services that I incur. But apparently, it doesn't work that way, But, I have the intention to put a complain to Medicare  and see  what happens.

 

 

Valued Social Butterfly
Posts: 8,793
Registered: ‎08-18-2008

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Message 5 of 89 (643 Views)

ykaplinsky wrote:

Gail, you are confused.  The doctor is not allowed to choose if he files with a supplement or an advantage plan no more than he is allowed to choose which insurance carrier he files with.  Advantage PPOs are a whole different world than supplements are.  YOU choose which you have and you and he are committed to using ONLY the one you choose. 

 

IF you choose a supplement, then by law, if a doctor takes Medicare, they have to take a supplement.  IF you choose an advantage plan, then the advantage plan has networks (supplements do NOT have networks) and a doctor can choose if he wants to be part of that network and accept their network reimbursement payments.  You choose, the doctor has to go by the rules of the plan you choose. 


You would have to keep up with all of rker321's post - but in my post I assume you are referencing, I said,

A doctor can decide which insurer they want to deal with and how much they want to deal with them.

A doctor even accepting Medicare assignment in original Medicare can still limit how many of this type of patient they accept into their practice.  The doc makes the call.

 

I understand what the subject of this thread is about (supplemental coverage) but sometimes threads just get off topic - it has very much so with the coversation between me and rker321.

Sorry.

 

You are right that once an original Medicare doctor (accepts assignment) elects to treat you, they will bill Medicare (CMS) for your sevices, Medicare (CMS) will pay 80% of their negotiated fee for the service and then send it on to your supplemental (Medicap) plan to pay their share since it is supplemental coverage.

 

You are right that if a doctor is within your Medicare Advantage plan's network, and he treats you, he will bill and be paid according to the fee schedule which the specific Medicare Advantage plan has with him.

 

However you are missing the point here and that is IF the doctor elects to treat you, IOW - he accepts you as a patient.

 

In a Medicare Advantage PPO plan, an out of network doctor can decide not to accept you as a patient - they have that choice.

 

In original Medicare, with or without a supplemental plan, even if a doctor accepts Medicare assignment, they still have the right to limit their practice scope to the number of Medicare patient which they treat.  That is why there is a selection, or use to be, on the Medicare Find a Doc site that says. "Accepting New Medicare Patients" - or if you call them for an appointment, they could tell you right then that they are not accepting any new Medicare Patients.

 

rker321 can tell you her specific circumstance but basically it involves a MA PPO of which an out of network doc has decided not to accept any patients that have coverage from a specific insurer - He was a long standing doc of rker321 which she had used in this MA PPO out of network capacity for a good while.  From my understanding it is really the result of the doc not liking the insurer for payment reasons, it seems -

 

The rest of this subject discussion is about possible a MA Medicare beneficiary going back to original Medicare and the circumstances underwhich they could get a supplemental ( Medigap) plan to "supplement" their original Medicare benefit - IF they can at all.

Conversationalist
Posts: 11
Registered: ‎07-28-2009

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Message 6 of 89 (650 Views)

Gail, you are confused.  The doctor is not allowed to choose if he files with a supplement or an advantage plan no more than he is allowed to choose which insurance carrier he files with.  Advantage PPOs are a whole different world than supplements are.  YOU choose which you have and you and he are committed to using ONLY the one you choose. 

 

IF you choose a supplement, then by law, if a doctor takes Medicare, they have to take a supplement.  IF you choose an advantage plan, then the advantage plan has networks (supplements do NOT have networks) and a doctor can choose if he wants to be part of that network and accept their network reimbursement payments.  You choose, the doctor has to go by the rules of the plan you choose. 

Valued Social Butterfly
Posts: 22,426
Registered: ‎03-04-2009

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Message 7 of 89 (677 Views)

Gail.

After reading your last post, I do realize that I know very little next to nothing about Medicare and how it works

If they are not health insurances those companies, what in the heck are they.? I am really not sure that I want to go to a simple medicare patient. I have always had the feeling that Medicare only patients are somewhat discriminated by the doctors themselves. is just a feeling, besides, Medicare only pays 80% of the bill and at least the other Insurances to cover more costs than the 80% and the drug prices are a lot better than if I just got a stand alone prescription drug  program. I don't have the advantage of negotiating like they do.
I realize what you are saying that the doctors have the last shot. in all of this, but, if they accept Medicare patients, and Medicare supplemental  why I as a PPO Medicare Advantage person they cannot bill my Medicare directly they do it for other patients. and bypass my PPO Insurance.

That seems somewhat a little lopsided.  and perhaps that is also not too fair to the consumer.
Perhaps, Medicare needs to be waken up of their dream land and start thinking about their rules a little. 

Valued Social Butterfly
Posts: 985
Registered: ‎01-02-2012

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Message 8 of 89 (727 Views)

ReTiReD51 wrote:

alexiss12 wrote:

 

Also one needs to know that when Obamacare was put into place, monies were taken out of Medicare to help pay for the tax credits etc under Obamacare, therefore reducing some of the benefits of us older people with our healthcare.So don't blame AARP or United Healthcare plans such as Plan F as they are controlled by Medicare guidelines that got more expensive when Obamacare went into effect. 


@alexiss12 

There was NO “monies”….”taken out of Medicare” NO “benefit cuts” because of Obamacare. This was disingenuous teaparty propaganda spread to discredit the ACA.

 

Obamacare achieved $716 billion Medicare savings through reduced physician and provider reimbursements. Just one example it required Durable Medical Equipment (DME) providers to be contracted with CMS to get paid from Medicare which helped to reduce a lot of fraud among the many DME providers. Waste and fraud were cut not benefits.

 

 Obamacares gave all Medicare beneficiaries, no cost preventative care and the gradual closing of the “donut hole for part D.
There were NO benefit cuts.
There were no “monies”…..“taken out of Medicare”.


Retired is correct. There was no money "taken out" of the Medicare trust funds by the Patient Protection and Affordable Care Act (PPACA) of 2010 as amended. What PPACA did was direct that the Centers for Medicare and Medicaid Services (CMS) spend a large percentage less on acute care hospital benefits, skilled nursing facility (SNF) benefits, and home health care benefits than CMS otherwise would have if PPACA had not been passed. The number that hospitals, SNFs and the VNA will not get equalled around $400 Billion for the years 2011 to 2020 and will equal close to a trillion dollars for the years 2018 to 2027.

 

The money did not go anywhere. It stayed in the Medicare Part A Trust Fund. But absolutely crazy government accounting rules let Congress say that the money was "saved," thereby allowing the Congress to pass PPACA under reconciliation (meaing it could not be filibustered even though a Republican had won Ted Kennedy's Senate seat taking away the Democrats' previous filibuster proof margin in the Senate).

 

The theoretical effect on people on Medicare is that hospital, SNF and VNA services got worse in proportion to the amount their income was cut. Some people (reasonably in my opinion) claim this theoretical poorer service at hospitals, SNFs and by the VNA to be a benefit cut.

 

-- The DME example given by Retired was small potatoes.

-- A few additional preventive tests were moved from the category of having a co-pay to having no co-pay (but race, age and frequency limitations were added). This benefit was smaller than small potatoes because the major preventive service used by people on Medicare, by a wide margin, is a flu shot and that has been available without a co-pay since the Bush administration - Bush 41

-- The slow reduction of the co-pay for the relatively few people affected financially by the donut hole has simply moved drug policy premium and drug co-pay costs on to the 80% of us that were never affected by the donut hole and the 15% of us who enter the donut hole but whose donut hole expenses were/are paid for by Medicare, Social Security (but even that's really Medicare), state pharmacutical assistance programs, Medicaid, and donut hole insurance riders either bought individually or received as a perk for former employment 

Valued Social Butterfly
Posts: 8,793
Registered: ‎08-18-2008

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

[ Edited ]
Message 9 of 89 (753 Views)

rker321 wrote:


 


Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare?

You know, perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental I believe that they have stopped asking the Foundation and just bill my insurance.

You wrote:

"Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare?"

 

YOUR Medicare IS the Medicare Advantage plan which you have chosen, I believe, a Medicare Advantage PPO.

 

A doctor can decide which insurer they want to deal with and how much they want to deal with them.

A doctor even accepting Medicare assignment in original Medicare can still limit how many of this type of patient they accept into their practice.  The doc makes the call.

 

Don't like any Medicare Advantage plan, go back to Original Medicare.

 

Original Medicare and Medicare Advantage plan (Part C of Medicare) cover the SAME benefits just in a different way.  They are both under the umbrella of "Medicare".

 

you wrote:

". . . . .perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental "

 

A Supplemental (Medigap) insurer has no cost exposure - they do not decide on the price or payment of anything !   They don't say what is covered or set any prices.   In General, they pay the 20% of the Medicare approved cost which Medicare does not pay.

Supplemental Insurance is NOT health insurance - it is "supplemental" insurance.

 

They can deny you coverage based on their own determination of the amount of services which you may use in original Medicare because you have a pre-existing condition and you do not have any Medicare determined rights that they have to sell you a policy at all OR sell you a policy even at the going price - they can deny you a supplemental plan, or underwrite you, charge you more and limit coverage for pre-existing condition for a specified amount of time..

 

At this point, we are waaaaaay off-topic and I am having my doubts that you understand Medicare and all its parts.  Nor do I think you understand what Medigap (supplemental) coverage actually is.

You seem to keep thinking that it is health insurance; it is not.  It does not work with a Medicare Advantage plan at all.

 

You have your choice of keeping a Medicare Advantage plan (Part C), any of them offered in your area, or going back to Original Medicare but perhaps without a supplemental plan or perhaps one that might be pretty costly, if an insurer will underwrite you.

Valued Social Butterfly
Posts: 22,426
Registered: ‎03-04-2009

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

Message 10 of 89 (784 Views)

GailL1 wrote:


To tell you the truth, rker321, I do not know what Medicare's (CMS) current stand is on the use of Avastin for AMD - it is being used "off label" - we have talked about this before.  Avastin has been proven to be a good way to treat AMD.  Yes, it is much cheaper than Lucentis or Eylea but it is still being used "off label". But yes, tremendously cheaper.

 

Here are the latest things I could find.

MedScape: 06/17/2014 - Switch From Lucentis to Avastin Could Save Medicare $18B

 

Previous research indicates that the 2 medicines have similar efficacy and safety profiles. The biggest difference is a $2023 per dose price tag for ranibizumab (Lucentis), which is approved by the US Food and Drug Administration (FDA) for both ocular conditions, compared with about $55 for a dose of bevacizumab (Avastin), which lacks federal approval for such uses. (that's the reason it is used off-label)

 

USA Today 04/24/2014 - Some top Medicare beneficiaries spend heavily to lobby

 

Medicare paid more than $956 million in 2012 to Genentech for Lucentis, more than any other drug — even as many retina specialists, backed by a two-year federal study — say that Avastin, another drug produced by the company approved to treat cancer, is as effective as Lucentis at treating the eye disorder. The disease is a leading cause of blindness in people older than 60.

 

Lucentis costs nearly $2,000 per injection; Avastin, about $50.

 

Are you getting help from the charitable arm of Genentech to pay for the Avastin?

 

I am sure that original Medicare does cover it under Part B but all of it, since it has to be recompounded, I don't know.  - ask your doctor.

Doesn't that $ 400 cover the cost for the office visit and the doc's time?

 

Just another question to ask and compare the coverage of original Medicare to your Medicare Advantage plan.

 

 


In the beginning they use one of those expensive ones, but eventually changed to Avastin, apparently I do better on Avastin. than with the other two.
The foundations that I am dealing with is called Gooddays. and they have been generous with me.
Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare? 
Yes, even this insurance does  cover Avastin.
You know, perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental I believe that they have stopped asking the Foundation and just bill my insurance.
I have seen the bill and there is a test that they do before they put the injections to see if there is any change in my eye. and then they put the injection. so is the injection plus the test and the doctor's visit. The insurance covers it all except for my copay for an specialist. Now, there is no progression for a very long time. as it is, I am going only about every 10 weeks and he wants to space it even more. I guess I was lucky, because I saw the eye doctor every six months because of diabetes, he was the one that saw that I could have a problem and immediately sent me to the retina specialist. I guess it was treated very early. is only in one eye and I can  see quite well under the circumstances and my other eye is not affected, and I have very good vision on that eye. I still can drive without a problem which is very important for me.