General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsHospitals and doctors are fed up with Medicare Advantage.
Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans is crescendoing. Some hospitals and physician practices are so fed up theyre refusing to accept the plans even big ones like those offered by United Healthcare and Humana.
The insurance companies running the Medicare Advantage plans are pushing physicians and hospitals to the edge, said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents the for-profit hospital sector.
Last week, the industrys largest lobbying group, the American Hospital Association, fired off a letter to the Centers for Medicare and Medicaid Services warning that some insurers seem intent on circumventing new rules put in place by the Biden administration aimed at reining in some prior authorization and claim denials.
https://www.washingtonpost.com/politics/2023/11/29/theres-growing-friction-over-prior-approval/
dalton99a
(81,656 posts)Baptist Health in Louisville, for example, has threatened that all of its nine hospitals, along with its clinics and physician groups, will cut ties with Advantage plans offered by UnitedHealthcare and WellCare Health Plans Inc. beginning in January unless they can come to terms.
The plans routinely deny or delay approval or payment for medical care recommended by your physician, the system wrote in a message to patients posted on its website.
The systems medical group, with nearly 1,500 physicians and other providers, left Humanas network in September.
And in San Diego, more than 30,000 people are looking for new doctors after two large medical groups affiliated with Scripps Health said they would no longer contract with any Medicare Advantage insurers. Revenue is not sufficient to cover the cost of patient care we provide, they said in a statement.
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orleans
(34,086 posts)i've gotten tons from a machine by the name of "eliza"
(fuck off "eliza"!)
Warpy
(111,397 posts)I hear that "blip" sound that indicates "I am a fucking robot" and hang right up. If some live person doesn't say "hello" right back at me when I pick up, that call is over. I don't care what they're selling, the phone is a service I pay for and I"m not paying to be advertised to death.
Online mail has done a decent job of getting rid of the worst spammers. I don't know why phone spammers can't be dealt with accordingly.
Shoot, whenever it gets bad, I unplug/turn off the phone. There have been times the damned thing has been off for a couple of weeks. The peace has been wonderful.
montanacowboy
(6,107 posts)by offering a free bag of groceries. Blood suckers.
Response to montanacowboy (Reply #3)
dalton99a This message was self-deleted by its author.
XanaDUer2
(10,780 posts)I'd love to know how much the monthly allowance is for for approved groceries. How does that work?
DownriverDem
(6,232 posts)It's for vitamins, dental products, pain relievers, lots of other care products & some food. I've see anywhere from $125 to $200 per quarter.
XanaDUer2
(10,780 posts)I may look into it, but two of my drs told me to stick with traditional Medicare. Which starts tomorrow
Rebl2
(13,579 posts)ago because she knew they likely would not cover some medication I take for rheumatoid arthritis. She seemed up to date on insurance because she has many older patients.
NowISeetheLight
(3,943 posts)I dumped my UHC policy and switched back to regular Medicare last week. I figure the 80/20 isn't bad when I have full VA available. As long as I notify them within 72 hours they'll pay first and I won't have a bill.
When I called UHC to end my MA policy it was like trying to cancel cable. They passed me around a bit and really tried to get me to stay.
XanaDUer2
(10,780 posts)ARPad95
(1,671 posts)XanaDUer2
(10,780 posts)Congrats. Took 2 yrs to get
ARPad95
(1,671 posts)Why did it take 2 years to get Medicare? My dh applied 2 months ago ahead of his 65th in December and got his card a couple of weeks ago.
XanaDUer2
(10,780 posts)ARPad95
(1,671 posts)XanaDUer2
(10,780 posts)I would have had no insurance for 6 months if not for obamacare. It was free to me
ARPad95
(1,671 posts)You can choose part A only, which I did when I was twenty two yo.-back in late 70s. My parents were able to keep me on their insurance as long as I lived with them. My dad worked at an insurance company and he saw no need for me to get part B at that time. I did get it when I turned 65.
madinmaryland
(64,933 posts)ARPad95
(1,671 posts)Hamlette
(15,412 posts)my husband fell for Medicare Advantage years ago when he signed up. I did not. so I'm happy to forward this to him to point out that . . .I was right AGAIN.
yardwork
(61,729 posts)My mom had Aetna managed care. She had many health problems, and was hospitalized a few years before she passed away. Her health had declined badly, she was in kidney failure, dehydrated, etc. She had a surgical procedure.
She needed a few weeks of rehab after hospitalization before returning to her independent living apartment. Her doctors warned me that Aetna would never approve it.
I fought and fought to get her a few weeks of rehab. Her doctors fought and fought. Aetna declined it over and over, wouldn't return calls, etc. Finally, I gave a check to the rehab center to pay for her care out of pocket, I was that desperate. The day of her hospital discharge Aetna finally relented.
After mom passed last year, I saw how many claims Aetna declined. The hospitals, providers, and hospice group are still trying to get reimbursed. It's ridiculous.
Chainfire
(17,671 posts)We need a sane health care system like other civilized nations have. We don't demand it, so we don't get it. There is no use crying about allowing ourselves to be taken advantage of.
XanaDUer2
(10,780 posts)I hit mute whenever Martha, Jimmie, or Joe come on
PoindexterOglethorpe
(25,919 posts)who has never had a problem with her Advantage Plan.
What am I doing wrong?
Emile
(23,043 posts)Scottie Mom
(5,812 posts)Scottie Mom
(5,812 posts)Scottie Mom
(5,812 posts)MOMFUDSKI
(5,731 posts)fine with my Advantage Plan for 10 years now.
likesmountains 52
(4,100 posts)I had a Medicare Advantage Plan for 2 years and loved it. Dental care, vision care, $50 to spend on OTC stuff every 4 months, gift cards for having a physical and getting a mammogram. But, in my smallish town we were very short of specialists and I would be out of plan for most care if I developed any health problems. When one of my siblings suddenly fell ill and died 13 days later of lung cancer, i realized that I needed a better spectrum of providers. I wouldn't try to talk anyone out of their advantage plan if they are happy and healthy, but just know that if you get sick, you might be hung out to dry.
Ferrets are Cool
(21,111 posts)Wifeys cancer medical bills have totalled over one million dollars. We have had to pay about 17k of that total. Without Advantage, we would either be bankrupt or she would be dead from a lack of coverage.
zipplewrath
(16,646 posts)"Regular" medicare really needs medigap insurance like you suggest. Otherwise, the 20% part can really bury someone. The flip side is that under Advantage plans, you can be restricted from the specialists and procedures you may need. IF you can afford medigap insurance, that's the way to go. But many people don't understand that medicare isn't "free" by any stretch for most people. Medigap is just another burden that is a hardship for many people.
If you don't experience serious chronic health issues, Advantage plans appear to be a really good deal. But if you develop serious, and expensive, health issues, they can quickly become a very serious problem.
LetMyPeopleVote
(145,722 posts)nevergiveup
(4,768 posts)I keep getting phone calls and mail from them and I can't go on either the computer or television without being blasted by one of their ads. At this point I consider all of it an invasion of my privacy. My hope at this time is that Elon Musk will buy the company because I know if he does they will go belly up in a couple of years.
Wonder Why
(3,290 posts)[link:https://tax.thomsonreuters.com/blog/court-rules-that-health-plans-informational-phone-calls-may-have-violated-telephone-consumer-protection-act/|]
I collected $1500 from our utility for making 3 calls to my wife. Never had to go to court but it can be an easy win if you document, document, document.
nevergiveup
(4,768 posts)Wonder Why
(3,290 posts)nevergiveup
(4,768 posts)edhopper
(33,646 posts)They could also bring about universal health care if they so chose.
One can only hope this nightmare leads to that
likesmountains 52
(4,100 posts)that it is part of Medicare. I got it 2 years ago by default when my supplemental plan kind of morphed into advantage. People are not properly informed that when you sign up for 'advantage" you are giving away your regular medicare. It is not an adjunct, it is a totally separate policy.
keithbvadu2
(36,980 posts)The Medicare Advantage Trap: In 46 states, once you choose Medicare Advantage at 65, you can almost never leave
https://prospect.org/health/2023-11-29-medicare-advantage-trap/
https://www.democraticunderground.com/100218490955