Community Chat

[Mindy D]

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@Annabellethecat66 wrote:

I have an insurance agent.  I've been with him for a long time.

I give him a list of my medicine and Drs and he puts them in the computer and out spouts out a few to choose from.

From there he delves further into each of them.

It doesn't cost me a penny.  I assume he gets money from the companies.

Sometimes he suggests insurance companies he doesn't even represent.  

He's very honest.  I go over to his house, fill out the papers, write a check so it is automatic withdrawl.

I have a few medicines I must have.  I always tell him they are the most important.

The prices through the years vary.  I saw where pressure is being put on these places that make the medicine for us to pay whatever Canada and Europe pays (which is always cheaper than US) for us to pay.

It's supposed to take place in a few months I believe.

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@Annabellethecat66 @Unless your agent personally calls the doctor's offices to verify, the agent would only know what the plans' information tells the agent. If the plans don't correct their information your agent is stuck with the wrong information too. 

[Mindy D]

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@noodleann wrote:

Great advice, @Mindy D . I've always known there can be changes throughout the year, but to have critical information like providers wrong in the open season decision-making data for consumers is scary. We should get a second shot at a provider in such cases, IMO. Never happen, but they could penalize the insurers who are providing bad info--unless it's the information sources (websites) failing to correct their databases.

Perhaps it's not a bad idea to double-check lists of maintenance medications if they're expensive, too, to make sure they're not listed as covered when not, or are a different tier, etc.

Caveat emptor.

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@noodleann @These changes weren't from just one year. My husband's insurance company also noted that one of the doctors was with them in 2019-2020 and I found out that this was not the case either. The insurance companies are not updating their databases or the books of providers they mail to you. The best solution is to cal the doctors offices to verify they take your EXACT plan. You might even want to call more than once in case you get someone that is not knowledgeable. I'll hint here about the insurance companies and say both are among the largest health insurers in the nation and both are, in other ways, known to be reliable, trusted companies. 

[Mindy D]

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@Cakers3 wrote:

@Mindy D   Do you have a PCP?   If so, let him/her make the recommendation(s).

Our PCP makes referrals because he knows the doctors/specialists and he knows who is in-network.  We have never had a bad experience with anyone he recommends.

Often the appt. is made while we are there or if the doctor/specialist calls they verify the insurance anyway.

Just a suggestion that always works for us. 

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@Cakers3 @I specifically chose these two doctors from my plan's list because of their unique qualifications. My PCP will only meet with the same problem I had. She will look for referral doctors she has regard for, from my plan's listing of specialists, and that listing contains incorrect information...so this would put me back to square one. I'm not worried. I'll just keep checking through the specialists that meet my criteria, are listed as on my plan and then I'll call to verify that they actually are with my plan. 

[ScrapHappy]

I always call my health care/insurance company AND office.  Plus I always get the name of the person(s) I'm speaking with and I ask for the insurance company to email the list of in network providers (Example: all ortho doctors).  

[Mindy D]

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@ScrapHappy wrote:

I always call my health care/insurance company AND office.  Plus I always get the name of the person(s) I'm speaking with and I ask for the insurance company to email the list of in network providers (Example: all ortho doctors).  

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@ScrapHappy I have the physical list and the suppos3dly updated online list. I didn't call the ins cop first because I happened to cal the drs office first to see how they are doing things for the pandemic. I just happened to ask if they were with my plan. Before I called I had checked and they were with my plan according to all the listings I had checked. I as surprised when they said they don't take my particular plan. After this I went on another search for a different specialist and when I called their office I got the exact same story. Both doctors had repeatedly tried to get information corrected for over a year.

[Annabellethecat66]

@Mindy D I don't change insurance companies (had the same one for a few years) I just change the prescription part of the plan.

[Carmie]

If you have a Medicare Advantage plan or are not on Medicare yet, but have insurance, check to see if your plan is a PPO or HMO.

Some providers participate in both types of coverage, some only participate in one type.

Example.  Kate has Health insurance  though Aetna.  Her insurance is a PPO plan.  She needs to go to a dermatologist, so she checks online to see if her chosen doctor participates with Aetna.  They do.

The problem, the provider is only participating with Aetna's HMO plan.  If she goes there, her claim will only pay the out-of-network amount according to her contract.

The OP is correct, the patient is 100% responsible to check beforehand to see if the provider is participating with their insurance plan.  There are many types of plan within any given Insurance company.

[Icegoddess]

Choice?  People have choices?  I can only choose between Bronze, Silver, & Gold Blue Cross Blue Shield plans.  $925/month for Bronze with a $6500 deductible. 

[Kachina624]

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@ECBG wrote:

Thank goodness as a former state employee, I'm on their plan.  We have a giant bargaining chip.

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@ECBG    Me too, and I pay no premiums or co-pays, have no deductibles.  Haven't paid a cent for years.

[Mindy D]

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@Cats3000 wrote:

We're very, very lucky.  We're on Medicare and Medigap policies.  We get all of our healthcare (except dental) through a major medical center.  All providers (primary care and specialists) there are covered.

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@Cats3000 @When I chose my plan it said my specialist was covered. My husbands said the same thing. We each have a plan with one of the major carriers. Don't take it for granted that a specialist you really want is with your plan even if your plans listing says so. Call the doctors office with your card in front of you and verify what will be fo 2020-2021 just to be sure. Since you have supplements you will probably be fine.