Silver Sneakers being droped by AARP recommended insurer

[John85259]

After a new series of phone calls I have some more info about Mayo Clinic.  Generally speaking, Mayo Clinic doesn't accept Medicare for primary care which includes physicals and that sort of thing.  They will make an exception if you had been a primary care patient at Mayo Clinic within the last 3 years, but they won't accept new Medicare patients in the primay care department.  Other departments at Mayo Clinic have different policies and may very well accept Medicare patients.  The information I received is for Scottsdale-Phoenix, Arizona and will likely be the same at other Mayo facilities.

This is far from the original topic of this thread but maybe it will be of value to a few people.

[GailL1]

@John85259

Mayo Clinic have specific ways they treat different Medicare plans especially in Florida and Arizona - traditional Medicare or varieties of Medicare Advantage plans.

Read this link

Mayo Clinic - About Medicare - Billing and Insurance at Mayo Clinic

It does not sound like they take Medicare Part B under the traditional program for the clinic and associated physicians on an ASSIGNMENT basis  EXCEPT for certain services.  They do take both Medicare Part A and B for hospital services.

If you have traditional Medicare and are looking for the clinic or affiliated physicians to act as your primary physicians, since they don't accept assignment, Medicare will only cover part of the fees for their services for many things.  You will have to sign an ABN  ( Advanced Beneficiary Notice of Non-Coverage ) acknowledging this and they will send you a bill of what is due.

Do you understand what it means if a doctor or other health care provider takes or does not take "assignment" in Medicare?  It means that by taking assignment the agree to accept the Medicare payment amount for their service - then Medicare pays their 80% of this amount and the beneficiary or their supplemental plan picks up the remaining 20%.  If they don't accept assignment then the beneficiary may have to pay what they charge over and above that amount.

Yes, it can also go by specific services too.

From the link:

Hospital services

If you are hospitalized, Mayo Clinic will file your Part A (hospital inpatient and outpatient services) and Part B (physician services) claims for you. You will receive a Medicare Summary Notice from Medicare when it processes your claim.

Clinic and physician services

Although Mayo Clinic doesn't participate with Medicare Part B in Arizona and Florida, Medicare will help pay for services provided at all Mayo Clinic sites regardless of whether they participate with Medicare Part B. Claims will be filed to Medicare Part B and supplemental or secondary insurance companies on your behalf. In some cases, Medicare Part B and supplemental or secondary insurance payments may be sent directly to you. When this happens, patients will be responsible for reimbursing Mayo Clinic for any payments they receive and any balances not covered by their insurance.

Medicare assignment

Mayo Clinic is required to accept assignment for Medicare Part B for certain services designated by government regulations (for example, clinical laboratory, drugs and biologicals).

Medicare supplemental or Medigap insurance crossover

If you expected your claims to cross over from Medicare to your supplemental or Medigap insurance and this did not occur, please contact your Medicare supplemental or Medigap insurance organization to inquire.

Medicare Advance Beneficiary Notice

Before certain items or services are provided, Medicare patients may be asked to read and sign an Advance Beneficiary Notice (ABN) that explains Medicare payment restrictions and estimate of charges. By signing the ABN, you assume financial responsibility in the event Medicare denies payment.

Noncovered services, such as eye refractions, foot care, hearing aids, screening exams, preventive medicine services and elective procedures, do not require prior notification and are not subject to the ABN requirement. Patients are financially responsible for all noncovered services.

Any questions regarding a noncovered item or service should be directed to Medicare at 800-633-4227 (toll-free).

Medicare Advantage plans

Medicare Advantage plans are plans offered by private companies that contract with Medicare to provide all of your Medicare Part A and Part B benefits. In most cases, Medicare Advantage plans also offer Medicare prescription drug coverage. There are various types of Medicare Advantage plans, including HMO, PPO, cost-based, HCPP, Medicare Medical Savings Account and private fee-for-service plans. If your plan is considered out of network, your out-of-pocket expenses will be higher. As a general rule, Medicare Advantage plans should process the same as Medicare.

The following Mayo Clinic campuses limit access to some of the Medicare Advantage plans:

Mayo Clinic's campus in Arizona. Patients covered by any types of Medicare Advantage Plans (exception Cost share/HCPP) that are not contracted may not be seen. Patients cannot be seen on a self-pay basis.

Mayo Clinic's campus in Florida. Patients covered by Medicare Advantage HMO plans without authorization may not be seen. Patients cannot be seen on a self-pay basis.

Mayo Clinic's campus in Rochester, Minnesota. Patients covered by Medicare Advantage HMO plans without authorization may not be seen. Patients cannot be seen on a self-pay basis.

Medicare Advantage HMO plans require authorization prior to scheduling appointments at the Mayo Clinic site that is contracted or that has accepted your plan; without authorization, the patient will be financially responsible.

Mayo Clinic's campuses in Arizona and Florida do not agree to the terms and conditions of noncontracted Medicare Advantage plans, due to administrative and financial challenges. Please refer to your Medicare Advantage plan for a list of in-network providers.

read more at the above link -

[ls63763447]

Don’t be afraid to look into alternatives.  All supplements cover the same as mandated by Medicare.

Customer service does differ.  I switched from United Healthcare to Cigna and was very pleased with the customer service person I spoke to at Cigna shortly after signing up.  She said that she has spoken to many customers who switched from UHC to Cigna due to UHC dropping Silver Sneakers.  Cigna has Silver &Fit which is accepted at our local gym and I have access to all the Silver Sneaker classes.  

[valerieb187708]

this was so helpful to me, thank you.     what scares me is making a change.     had a hip replacement this past year (my first and only operation!) and was very happy with the coverage.     so i thought having a 'history' would be a good thing.   but now, it seems things are changing.     don't really trust aarp anymore, or feel the same about united.    never did receive the 'early' notice of the silver sneakers deal, and it's a real conundrum to know what the best thing is to do for the long run.    

[John85259]

Diane and Valerie and Everyone Else,

I scheduled my physical at Mayo Clinic - Scottsdale for Jan 22 so it will be a while before I get over there.  When I'm there I'll see if I can find someone who will give me the straight scoop on how they handle new patients and what the financial details are.  I'd like to know how the money moves around and if there are any gaps in coverage that I need to know about.

My first thought is that I should post what I find out on this thread because it could also be of interest to people who live in other parts of the country too.  But it's wandered off quite a bit from the original topic and might deserve it's own thread.  If anyone has any preferences about this make a posting here and let me know.

I failed to mention in my previous posting that the two people who were quickly admitted to Mayo - Scottsdale for serious health issues were both around 70 years old.  I know for sure that one of them had never been there before and I'm pretty sure the other hadn't either.  So it appears that Mayo will take new patients in our age group if their particular situation warrants it.

Diane, what are the odds that there would be two people in the same area who are exactly the same age and have the same insurance (or maybe we should say "had") and are dealing with the same primary health care organization and are talking about it on the same internet forum?  My guess is somewhere between one in a million and never.  It shows the benefit of having the internet at our disposal to share what we know and benefit from the knowledge of others.

And while we're sharing knowledge feel free to pass along any hot stock tips you might have too.

John

[valerieb187708]

thank you for such great indepth experiences!      it's much appreciated in the confusion of insurances!

[d72142m]

John85259,

I read your previous post, which helped me tremendously. I too am in Az , started medicare in September,  and HAD UHC plan F.  I am also a Mayo patient.

Thanks to you, I realized I could switch my F plan without going thru underwriting (I most likely would not have had a problem, if I had to answer questions,  but who knows) as I was also within the first few months,  I switched to Humana effec 12/1/18 because of Silver Sneakers and lower rate (see my other post).  A note for you, we in Az can change our supplemental plan ANY time of the year, but may be subject to underwriting (answering health questions). I looked into Silver and Fit, but was told by the YWCA that we could still go to more than one gym, but could only be signed up for one gym at a time, and that I would have to dis-enroll from one to sign up for another. I liked the idea of being able to try different gyms, maybe within the same week.

Here's another tip for you on Mayo. Here's my understanding of Mayo in Az,  they will only take you st medicare age if you've previously been going there.

Billing for Mayo ...I just spent time on the phone with Medicare trying to figure out why a Dr bill was not paid at 80% of what medicare approved. (My F plan will pay the diff between what Mayo charges and what Medicare approves (this is called part B excess) as Mayo does not accept assignment of medicare in AZ. My plan F will also pay the 20% that medicare does not pay. Now this is the confusing part....Medicare calculates 80% of the amt they approved, then they deduct 2% of the 80%, then cut a check to me for that amount. They called it 'sequestration' because AZ Mayo does not accept assignment of medicare. One needs a finance degree to figure this out. I've considered looking for another family care dr as I don't want to be recieving checks, then havkng to pay the bill (I believe it's only the dr bills, Bills for labwork was paid directly.  It is quit convoluted and confusing! Good luck to you, Diane

[John85259]

The article on the Kaiser webpage said that Humana had tried to get rid of SilverSneakers but customer complaints convinced them not to.  Maybe Humana felt they couldn't afford to lose any customers while United Healthcare thinks the few people they lose won't be enough to worry about.

Here's an update on Silver & Fit:  They don't have an ID card that shows a gym that you're a member.  The lady I talked to at Silver & Fit said that I'd just need to take in my ID number and that's all that would be needed.  They also have an index of gyms on their webpage from which you can select one as "your healthclub" and print out a letter of introduction that you can show them.  I didn't see anything that would keep you from printing out a letter for several gyms.  I like the ID card that SilverSneakers has.  It simplifies things.  Maybe Silver & Fit will eventually choose to have one too.

After only 2 months with United Healthcare I changed to Blue Cross - Blue Shield of Arizona.  I could do this because I was still within the window of my initial sign up with Medicare.  I haven't used any benefits from either United Healthcare or BC-BS AZ so I can't comment on whether one is better than the other in that arena.

Here's my experience with Mayo Clinic in Scottsdale, AZ in case anyone else is considering using them.  When I called them to ask about the "Introduction to Medicare" visit they said they don't offer something like this.  I was transferred to their new admissions office and put on hold.  About 15 minutes later the call was terminated.  I don't know if it was caused by a problem with the phone system at Mayo or somewhere further downstream.  My phone was okay and I've never had a problem with terminated phone calls so I don't think it was on my end of things.  I went to the Mayo webpage and found a link to a page where you can inquire about setting up an appointment.  I filled out the info and said I was a new Medicare patient and had BC-BS AZ insurance and wanted to see a general practictioner for a review of my current health situation.  I received an email the next day that said " Mayo Clinic is not accepting new patients with government insurance in the specialty department you requested..." and gave a phone number I could call with any questions I might have.

I decided to try a different direction of attack.  I called Medicare and talked to a nice lady there about my situation and she suggested that I use their doctor directory to see if any doctors at Mayo are in their list.  As we were talked we both walked through the process of searching their doctor directory and we both found that for general practice there were 10 or 11 doctors at Mayo in Scottsdale, AZ listed as accepting Medicare patients.

Armed with this information I called Mayo again and asked to have an appointment with one of these doctors.  During our conversation I mentioned that I had been a patient at Mayo in the past.  It was over 10 years ago and they supposedly purge their records after 10 years so I didn't think I was still in their database.  The woman I spoke to showed some initiative and found in their records that I had called them within the last 10 years to the doctor who had done my physical a question.  So, I was still in their database and had a patient ID number, therefore I was still a patient of Mayo Clinic.  This was good news.  Then the lady at Mayo asked for my insurance info and looked it up and said my insurance with BS-BC AZ was good at Mayo Clinic and they'll pay everything Mediare doesn't cover.  Then  she asked me if I'd like to set up a visit for a physical.  We scheduled one and that was it.

It was somewhat of an ordeal to get hooked up with Mayo Clinic again but the phone call I made almost 10 years ago saved the day.  I have no idea whether they'll accept new patients with BC-BS AZ or other insurance for general medical care like physicals and that sort of thing.

I have several friends who had serious health problems and were referred to Mayo Clinic by their doctors and they were accepted very quickly and received excellent care, so it appears they are more flexible when dealing with people who really need them for something serious.  Since I'm in good health and don't take any medications maybe the folks at Mayo want more of a medical challenge than I can offer them.

I can say that 95% of the time I've received really great service from everyone I've dealt with in my transition to Medicare.  I've called Medicare at least 5 or 6 times with questions and always received excellent service.  Same with United Healthcare when I was begining my coverage with them and when I called to tell them I was leaving.  The people I've spoken to at BC-BS AZ were equally helpful.  And last but not least the folks at Mayo Clinic in Scottsdale have also been good to deal.  Thought I'd give all of them a pat on the back in a public forum.  Customer service from people who care definitely makes a difference.

[FreedomRetirement]

Sorry your agent did not know this.

AARP/UHC says that you can move form one plan to another, internally. Prior to October 1, 2018, they touted this benefit as your being able to do it any time you wished, with no Underwriting required.
What is not disclosed is the fact that when you are already a customer and then move to another plan within the company, underwriting or not, you pay a different rate than the street/published rate. You are far better going to a Plan G, or better, Plan N, with a different carrier. See www.PlanNMedicare.org

[wonsettler]

As I've stated recently I've canceled my UHC plan F that I've had for 12 years and went to Aetna plan G. My savings will pay for my wife's and my gym costs with some left over. I went to a different Part D and save over $1,200 annually. The bad news, my wife cannot leave UHC because of previous conditions (that occured over the past 5 years since she's been on UHC plan F - she has been on UHC plan F for 11 years) so I applied for UHC plan G for her. The insurance agent said it would save approximately $500 annually but after underwriting the plan G ended up to be $1,200 a year more expensive than the current plan F. What a kick. We are going to fight the underwriting because they came up with some really weird conditions they claim my wife has but in the meantime I'll keep her on the UHC plan F. What a circle  jerk.