Advantage plans & co pay for in hospital care ... - Page 4

151949 · ‎03-09-2010

@Snowpuppy wrote:
@esmerelda wrote:
@151949 No, I hadn't read that. There's a lot I don't read.

what does TKR mean?
You didn't read that they are both diabetics, DH suffered a stroke, he needs hearing aids and on another post she said she takes meds for high BP and pain meds, has had knee & ankle surgery, he just spent 4 days in the hospital after a routine procedure but she considers themselves relatively healthy.

Personal attack - great e4xaggeration and some just not true.

151949 · ‎03-09-2010

@Drythe wrote:
@151949 wrote:
@Drythe I think you may be confusing the ACA and medicare.
@151949

How sweet of you, but be assured that I am not 'confused' in the least. As a Health Care Professional I am very familiar with coverage options.

Because a person has information outside your knowledge, or different experience than yours, or even a different opinion, does not make them 'confused', and is no reason to cast aspersions.

I believe Name calling does not advance understanding, so I see no value in continuing this convo.

Finis

Funny - I just googled medicare and government supplements and nothing came up.

lulu2 · ‎03-09-2010

@Nicknack wrote:
I have an Advantage plan. Recently I had a colonoscopy. The total charges were $1,690. The plan paid $87.88, and I had to pay $275. After the colonoscopy I had to have an endoscopy, and the charges and my co-pay were the same. I was surprised that I had to pay so much for something that was completely necessary. I was also shocked at how little the endoscopy center was paid. I didn't have to pay anything for the doctor's fee.

I've only been on Medicare for about a year and a half, and this was my first experience with having any major charges.

@NickNack

I'm sorry to read this. I had a colonoscopy and an endoscopy in both 2015 & 2016. I have traditional Medicare, (parts A & B) as well as NJ BC/BS and did not pay a penny either time.

When I saw what Medicare and BC/BS paid, it was not anywhere near the billed price of the procedures. The bottom line was, I was not responsible for the difference.

proudlyfromNJ · ‎05-01-2010

Concerning Advantage plans, I usually read here that most Doctors or practices won't accept them. Then I read a thread in Wellness with a poster on the west coast says all Doctors in her area want Advantage plans or they won't take you. I guess it depends on the state you live in.

151949 · ‎03-09-2010

@proudlyfromNJ I've had an advantage plan for 7 years and it has never been refused by any doctor - when we had our PPO we did go out of network at times and - no problem with any doctor accepting it. Now - with HMO going out of network is not allowed , so, of course all the in network doctors take our insurance. Since advantage plans are all managed care plans of one type or another - you are really much better off to simply stay in network.

For probably the last 20 years we were working our employer health care was also a managed care plan so this is certainly nothing new to us.

Margo Channing · ‎03-09-2010

@Drythe wrote:
@151949 wrote:
@Drythe I think you may be confusing the ACA and medicare.
@151949

How sweet of you, but be assured that I am not 'confused' in the least. As a Health Care Professional I am very familiar with coverage options.

Because a person has information outside your knowledge, or different experience than yours, or even a different opinion, does not make them 'confused', and is no reason to cast aspersions.

I believe Name calling does not advance understanding, so I see no value in continuing this convo.

Finis

She Just CAN'T HELP HERSELF.

viva923 · ‎03-12-2010

my husband was hospitalized early april for pneumonia (3 day stay). We have not gotten any kind of medicare statements or 2ndary insurance as of yet, but so far they have paid for everything for him over the past several years. He has not been admitted before this (since we went on medicare). This time the pneumonia was quite serious and had to have oxygen to just keep breathing. He is healing but still has a trace of pneumonia in his left lung. A very stubborn case of this bug

Margo Channing · ‎03-09-2010

@151949 wrote:
@Snowpuppy wrote:
@esmerelda wrote:
@151949 No, I hadn't read that. There's a lot I don't read.

what does TKR mean?
You didn't read that they are both diabetics, DH suffered a stroke, he needs hearing aids and on another post she said she takes meds for high BP and pain meds, has had knee & ankle surgery, he just spent 4 days in the hospital after a routine procedure but she considers themselves relatively healthy.

Personal attack - great e4xaggeration and some just not true.

Oh the irony!

hyacinth003 · ‎03-12-2010

@on the bay wrote:
@151949 wrote:
@CLHS68 Sorry I don't have an answer for you on this because here in Florida it is illegal for them to do this. If you have to use anesthesia or radiology at an in network facility and you have no choice to use someone else who is in network - they are required to pay the same as if he is in network. I would just pay it and then turn it in to be reimbursed.
That is pretty incredible. Many states don't do this and thats the scary thing-the insurance may pay the doctors, hospital but the radiologist who reads reports or others may not be covered in some plans and thats where it gets scary.
I wish all states had that it was illegal to do this-not cover all who are involved.
And its pretty difficult to ask who everyone is who will be involved and ask if they are covered.
It shouldn't be this way-so complicated for everyone involved.

We just had to sign my husband up for Medicare. I think the whole thing is very complex, and I consider myself pretty well informed.

I do not think all of this should be so COMPLEX for people to have to handle. If I had a hard time with it (and still don't claim to understand it all), I cannot imagine what some other people have going on.

Hyacinth

Kachina624 · ‎03-10-2010

@151949 Not that it's a competition, but I think I have you beat on the advantage plan. I can see any doctor, specialist or use any medical facility. I've had major surgery but never paid a penny, including for 2 weeks in a rehab facility. I have Silver Sneakers and get an annual vision exam. I do have to pay $16/mo for dental insurance but it includes all services. I also have drug coverage included.

I think the opposition had seen plans with a lifetime maximum benefit and was against them for that reason. I have no lifetime maximum. All Advantage Plans are different.

New Mexico☀️Land Of Enchantment