Re: 👉🏿 Medicare & You 2017 👈🏿

Mz iMac · ‎07-26-2014

@Carmie wrote:
You can even sign up to view your claims. No need to keep those EOMB's you are sent.

This is actually not true. Many "seniors" do not own computers and/or printers.

And for those that do......

Many (like myself) do not keep/save "personal" information on the HD.

If your internet service goes down and/or your comp or mobile device starts acting up, you will be unable to "see" your EOB's. This always occurrs when you need to print them out to discuss a "billing" dispute.

It is ALWAYS best to have a PLAN B - go get those paper EOB's that you get in the mail.

As a former boss told me eons ago, ALWAYS COA!

"Never argue with a fool. Onlookers may not be able to tell the difference."

Mz iMac · ‎07-26-2014

@hckynut

The state I live in has a department called Division of Insurance - Consumer Protection Services which is ruled by the Insurance Commissioner.

This dept monitors all insurance companies. They decide which insurance companies can do business in the state as well as which counties they can work in!

If a consumer cannot resolve a dispute w/their ins comp, the consumer can file a complaint w/the Ins. Comm.

I am not sure if other states have the above options. I believe NY does as well as Pa.

"Never argue with a fool. Onlookers may not be able to tell the difference."

Hooty · ‎03-09-2010

I got mine in the mail today!

Mi47 · ‎05-18-2010

Husband and I have the ruby advantage plan with blue cross blue shield. Recd 2017 updates yesterday. Premium stayed the same $89.00 a month. Co- payments same, most of coverage the same. Plan added some dental and hearing aid coverage. I'm happy can't complain.

Carmie · ‎10-25-2010

@Mz iMac wrote:
@Carmie wrote:
You can even sign up to view your claims. No need to keep those EOMB's you are sent.
@Carmie

This is actually not true. Many "seniors" do not own computers and/or printers.
And for those that do......
Many (like myself) do not keep/save "personal" information on the HD.

If your internet service goes down and/or your comp or mobile device starts acting up, you will be unable to "see" your EOB's. This always occurrs when you need to print them out to discuss a "billing" dispute.

It is ALWAYS best to have a PLAN B - go get those paper EOB's that you get in the mail.

As a former boss told me eons ago, ALWAYS COA!

Oh it is true. You can, but if you don't want to, then don't,

My health insurance company NEVER sends out EOB's unless you call to request them individually for each claim. If I want to view them, I need to go on line to do so.

iIt is only a matter of time before all insurance companies adopt this.

Also, there is no need to store EOBs on your hard drive. Why would anyone do that? You don't have to download anything to view your claims, and there is no reason to keep copies.

For most people there iare no billing disputes and if there is, You can always get a copy from your insurance company.

I once had a request to send EOB's for every claim that an individual incurred for the past 10 years for a lawsuit. There were so many that I had to send them out in a box that weighed alsmost 30 lbs. it took me two days to get them all.

conlt · ‎03-16-2010

Wow $360 a day for a hospital stay? I would run from this plan. If you have something really wrong with you, you could end up in financial trouble.

Carmie · ‎10-25-2010

@conlt wrote:
Wow $360 a day for a hospital stay? I would run from this plan. If you have something really wrong with you, you could end up in financial trouble.

She said her out of pocket was $6700. So including all of her other expenses, the most she would be responsible for is $6700. That is still a lot of money.

In today's health care world, the hospital usually doesn't keep you too long. They send you home and you get home health care nurses, physical therapists, etc.

terrier3 · ‎03-10-2010

@Carmie wrote:
@hckynut wrote:

@Mz iMac

It is about time insurance companies cannot monopolize a city/county or state. Every person should have a choice of what company they choose any company in the business. Who made the rules of insurance companies cannot operate in all 50 states?

I was a victim of a company charged as being a monopoly and was broken up into 3 companies. Many thousands lost their jobs, and thousands like myself lost, over many years, 6 figures of $$$ because of the decision of one Judge Green.

Where is a Judge Green with the Monopoly of these Health Insurance Companies?

hckynut(john)
Ah, this was brought about by our Federal Government who wished to regulate health plans within the state borders. It was set up to stop interstate competition.

You can get more information if you google McCarran-Ferguson Act of 1945.

This Act was set up so Insurance Companies could not have a Monopoly.

It wasn't really set up to stop interstate competition.

ALL financial matters are regulated by each state. State's rights take precedence.

National insurance companies can operate in each state as they choose, but they must pass rules and regs of each state and county.

Thus we have national companies like Aetna, national franchises like BCBS and regional and state wide companies too. They are all private businesses and can set up shop wherever they choose, as long as they follow local law. In practice, they often don't want to be in too many areas because its expensive to create and manage provider networks. An insurance company with few providers won't be very successful and since providers are local, local, regional and statewide insuers can operate more effectively and efficiently.

This law was created because some states had very little competition and associations acted like monopolies, pushing prices high.

terrier3 · ‎03-10-2010

@Mz iMac wrote:
@hckynut

The state I live in has a department called Division of Insurance - Consumer Protection Services which is ruled by the Insurance Commissioner.

This dept monitors all insurance companies. They decide which insurance companies can do business in the state as well as which counties they can work in!

If a consumer cannot resolve a dispute w/their ins comp, the consumer can file a complaint w/the Ins. Comm.

I am not sure if other states have the above options. I believe NY does as well as Pa.

Yes...all states have Financial Services that regulate things like banks, stockbrokers and insurance companies and their agents/brokers.

As long as insurance companies follow the rules set up in each state, they can operate. It is based county by county in NY (because of provider network considerations - people usually go to providers in their own county.

The Commissioner isn't actually "picking and choosing" who can operate. The insurers have to prove they are solvent, offer all basic benefits according to the law, set up viable provider networks, offer formal review and recourse, etc.

States don't LIMIT insurers, but companies are private and tend to want to operate where they can make the most money for their stockholders.

Cakers3 · ‎06-17-2015

@Carmie wrote:
@151949 wrote:
@Cakers3 wrote:
@elated wrote:
i am with Aetna and the copays have gone up $10.00 for all visits- Primary Care Visits $5.00 to $10.00; Specialist Visit $40.00 to $50.00.. Also, they have upped the maxium out of pocket to $6,700 from $5,500. inpatitent hospital stay $360.00 per day from $295.00 per day for additional days. Part D Prescription Drug Coverage Deductible from $125.00 to $400.00.
@elated But do you have the HMO or PPO plan? There is a difference in their plans.
Also, Aetna bought Humana and they are trying to consolidate the benefits between the two companies.

Most primary care doctors in my area no longer accept HMO plans whether regular insurance or Medicare Advantage plans, athough patients whose HMO plans were accepted prior to the decision will still be accepted. In other words, no new HMO patients will be accepted.

An insurance company can not run a managed care system in an area unless they have adequate coverage for their patients. In other words - before they can start to sell an HMO plan they have to show the state's insurance regulators that they can adequately cover all the patients needs for PCPs and specialists within that selling area, or they will not get the go ahead from the state.
What you are stating is true, but years down the road, many providers have discovered that they are losing money on their HMO patients. Their solution is to limit the number of HMO patients that they will take. They will not see any new patients who have HMO, but still see their existing patients.

This is a BIG problem inn some areas where their are not enough providers who participate who are accepting new patients.

This is even a bigger problem for those with Advantage Medicare HMO's. The people who have these plans have no where to turn when they can't find a doctor who will accept them when their current Doctor retires, closes the business or no longer participates in the HMO system.

They can always pick up Traditional Medicare, but they have an impossible time finding a supplemental program that they can afford, the longer you wait after being first eligible for Medicare Part B to purchase a Suppliment to Medicare, the higher your payment is.

Insurance is VERY complicated and even the people who are supposed to be helping others make a decision to buy are confused or uninformed. There are too many "what ifs." It's difficult to know what questions to ask when you make your first time decision to purchase. You need to think ahead.