Hospitals, doctors drop private Medicare plans over payment disputes

[DrQ]

Hospitals, doctors drop private Medicare plans over payment disputes​

Hospitals, doctors drop private Medicare plans over payment disputes

Hospital, insurer fights become public as hospitals seek adequate payments and health-insurance companies attempt to check spiraling medical bills.

www.usatoday.com

 

[Brett]

Hospitals and physician practices are now "tech-driven revenue cycle management companies"

 

[WinniWoman]

I chose a medigap plan (G) for fear of this very thing. Plus not having to hassle with where to go and what is and is not covered and copays, etc.

 

[dago]

I agree with Mary Ann. That's the main reason I chose traditional Medicare. Actually, I think this is old news.

 

[DrQ]

I agree with Mary Ann. That's the main reason I chose traditional Medicare. Actually, I think this is old news.

You would think, but with the barrage of Medicare Advantage commercials on TV this time of year.

Have you ever seen a commercial for a "Medigap" (Medicare Plan G or N)?

 

[dago]

You would think, but with the barrage of Medicare Advantage commercials on TV this time of year.

Have you ever seen a commercial for a "Medigap" (Medicare Plan G or N)?

Nope

 

[Brett]

Medicare - It's open enrollment time !


(I have United Healthcare supplement plan)

 

[isisdave]

I don't think I had previously see Medicare Advantage referred to as a "Private Medicare plan," which suggests that it is not Public, and therefore subject to restricted access.

 

[DrQ]

I don't think I had previously see Medicare Advantage referred to as a "Private Medicare plan," which suggests that it is not Public, and therefore subject to restricted access.

It is "Private" (Outside company) which takes the place of Medicare A & B. The company gets an annual per head fixed payment from CMS, but then the costs are controlled by:

• Provider Networks
• Primary Care Physicians
• Pre-authorization of medical procedures
• Copayments (Maximum Out of Pocket expense - Pay as you go model)

Much like the "Private" health insurance offered to employees under a group plan.

Private refers to the entity offering the insurance, not the access.

 

[jorcus]

Even the part G plans can be slow to pay providers. My wife discovered it took 6 months to pay for a particular visit. According to our AAA Medicare helper the plans with the higher ratings tend to have a better relationship with the providers.

 

[dougp26364]

Advantage plans, as I understand them, are privatized, for profit, replacements for Medicare. What I’ve seen of them reminds me of the old HMO health care plans that promised the world but, when it came time to provide services, would routinely deny benefits.

 

[DrQ]

Even the part G plans can be slow to pay providers. My wife discovered it took 6 months to pay for a particular visit. According to our AAA Medicare helper the plans with the higher ratings tend to have a better relationship with the providers.

Less of an issue with "Medigap" policies as they usually only cover the %20 of Medicare Part B costs. If you REALLY get sick and have to tap Part A coverage, the provider still has the lion's share from CMS.

 

[rapmarks]

We have Medicare advantage through our retirement. My husband was hospitalized twice, $52000 each. Medicare allowance was paid, and one year later, they took the money back, saying the hospital hadn’t followed proper procedures Every procedure needs pre approval, even an ultrasound.

 

[DrQ]

We have Medicare advantage through our retirement. My husband was hospitalized twice, $52000 each. Medicare allowance was paid, and one year later, they took the money back, saying the hospital hadn’t followed proper procedures Every procedure needs pre approval, even an ultrasound.

Were you able to appeal or are you on the hook for $100K?

 

[dago]

Were you able to appeal or are you on the hook for $100K?

I have a supplement plan and when I was hospitalized for 23 days following a surgery, I ran up a hefty bill. I saw many doctors and had many procedures done. Everything was seamless and I had zero out of pocket.

 

[DrQ]

I have a supplement plan and when I was hospitalized for 23 days following a surgery, I ran up a hefty bill. I saw many doctors and had many procedures done. Everything was seamless and I had zero out of pocket.

That question was directed to @rapmarks who has an Advantage plan with over $100k that was rejected after a year of being paid. Many retirement plans are forcing recipients into Advantage plans. I have a friend that retired from a large defence contractor and the Advantage plan was part of the retirement package.

New York City just had their lunch handed to them:

Judge ‘Permanently’ Bans Medicare Advantage Switch for City Retirees

The Adams administration had intended to switch 250,000 retired public-sector workers to a controversial privately run health care plan on Sept. 1.

www.thecity.nyc

 

[dago]

Kudos to the Judge

 

[rapmarks]

Were you able to appeal or are you on the hook for $100K?

No I didn’t owe a cent. The hospital appealed but I never saw a reversal

 

[DrQ]

No I didn’t owe a cent. The hospital appealed but I never saw a reversal

It's good that the hospital was able to appeal and get paid, but that is still stress that insured should not have to endure. That kind of hoop-jumping is why I went with Medicare Plan G to avoid in claims.

 

[rapmarks]

It's good that the hospital was able to appeal and get paid, but that is still stress that insured should not have to endure. That kind of hoop-jumping is why I went with Medicare Plan G to avoid in claims.

No hospital did not get paid

 

[DrQ]

'Deny, deny, deny': By rejecting claims, Medicare Advantage plans threaten rural hospitals and patients, say CEOs​

Medicare Advantage plans "are taking over Medicare and they are taking advantage of elderly patients," said the CEO of one Mississippi facility.

By denying claims, Medicare Advantage plans hurt rural hospitals, say CEOs

Medicare Advantage plans "are taking over Medicare and they are taking advantage of elderly patients," said the CEO of one Mississippi facility.

www.nbcnews.com

 

[rapmarks]

Case manager at hospital told me it is very hard to find home health agency to agree to work with my Aetna Medicare insurance.

 

[rapmarks]

Just returned from hospital stay to find a letter from insurance rejecting the pet scan I had last week, which showed something new that was biopsied for the surgery, saying he had one in July so couldn't have another.
I had surgery this past Monday and looks like the surgery approval has now been paused, although it was approved last week. The insurance is really screwing with me. Medicare Advantage at its best.

 

[PigsDad]

This whole thread has convinced me to stay far, far, FAR away from any Medicare Advantage program when I turn 65 and have Medicare decisions to make.

Kurt

 

[emeryjre]

All plans seem to have one thing in common
The more the plan costs, the more things get covered
Part A, B and medigap plan F extra (now called G)
It costs about $450 a month for 2024
The neighbors (husband and wife) on a advantage plan were told that their doctors and hospital network would no longer accept their coverage
Their new insurance is going to cost them about $800 a month
Is least expensive plan they could find that would be accepted by by current doctors and hospital network
She has lung cancer and he has a long list of ailments
They are lucky to be able to get coverage with all of their pre existing conditions
But they were not prepared for almost 10K in medical insurance costs for the future