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Valued Social Butterfly

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

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Message 1 of 91

@emmafaithm1969

 

Something definitely does not sound right here with whatever the problem might be between the doctors orders and your Medicare Advantage plan.

 

But without all the details, you should file a complaint with Medicare about your Medicare Advantage insurer so that they can check into the details and determine the problem.

 

Medicare.gov - Complaints about you health or drug plan

 

A Medicare Advantage medical staff do have the right to question things which might go contrary to the diagnosis code a doctor may use.  

 

Sometimes it it might be just a simple code number being entered wrong but it would not take 4-weeks to come to a conclusion IF everybody is on the same page to get everything right.  Since your prescription drug coverage is embedded in the same plan, it could be a problem either on the provider end or the prescription end with the insurer.

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Info Seeker

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

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Message 2 of 91

I don't know about their supplemental insurance, but their complete plan has been a total nightmare for my health, especially my kidneys. Twice, within just a few short months, they refused to approve refills on my hypertension medication I've been taking for years, and forced me to go without it for about 4 weeks total while fighting with my healthcare provider who constantly tried to make it clear I needed my medication to protect my kidneys. (I had CKD Stage 3b at the time of the denial, which may be worse now.) The last lab results showed protein was spilling into my urine. Further damage to my kidneys! Anytime a doctor or his office has to argue and fight with an insurance company about your care, there is a serious problem and the patient is the one who suffers.

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Conversationalist

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

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Message 3 of 91

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. 

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Valued Social Butterfly

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

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Message 4 of 91

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.

 

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Valued Social Butterfly

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

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Message 5 of 91

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 -

 

 

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Valued Social Butterfly

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

1,738 Views
Message 6 of 91

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.

 

 

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Valued Social Butterfly

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

1,746 Views
Message 7 of 91

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.

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Conversationalist

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

1,753 Views
Message 8 of 91

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. 

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Valued Social Butterfly

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

1,780 Views
Message 9 of 91

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. 

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Valued Social Butterfly

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

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Message 10 of 91

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 

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