Reply
Honored Contributor
Posts: 8,420
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of


@Mz iMac wrote:

@lulu2

 

If BC/BS is your PRIMARY, you need to contact them ASAP to relay what the manager for the neuro told you.  Then let them deal w/the primary to secondary ins discripancy.

 

@Mz iMac

 

As I am 65, Medicare is my primary insurance and BC/BS is my secondary.  It is my secondary insurance that is out of network. 

 

Because Medicare pays so little, many practices accept it, but not any other insurance.  This way they do not get pennies on dollars as final payment.


Honored Contributor
Posts: 12,262
Registered: ‎03-16-2010

Re: You Have To Be Aware Or Get Taken Advantage Of


@hckynut wrote:

 

I started handling big amounts of money (big in that era) when I was 12 years old. Took me lots of hard work to earn every penny I put in my pocket. Had high school car loads try to beat me out of a nickel here, a dime here, and they were unsuccessful.

 

Over many decades I have had many try the same. Some seem to look at easy going laid back men as an easy target, a fish. They would throw in there lure, and sometimes I would bite just to amuse myself. They found out will I bit the lure they could never complete their attempted catch.

 

When it comes to my money transactions, the only one I trust is myself. For people to do otherwise I see as a mistake. Know everything you need to know to understand every transaction of money from your hands to another. Knowledge is power, the more you secure the better off you will be, especially when it concerns your $$$$.

 

@jordan2. I hope everyone reads this very carefully. Nice of you to tell your story to try to help/warn others.

 

 

hnj


@hckynut Thank you so much!

Honored Contributor
Posts: 12,262
Registered: ‎03-16-2010

Re: You Have To Be Aware Or Get Taken Advantage Of


@151949 wrote:

Wow your Mom has an advantage plan with 0 copays?? Who does she have that with?  what is her premium?


She worked and when she retired she was Medicare and had her union local as her secondary insurance. That then changed as the local didn't want to pay for the 20% anymore. They kept changing her insurance plan (I guess to save money for the local) She now has United Healthcare a Senior managed Medicare, it is all inclusive. I believe she pays monthly payments for the insurance ( I'm assuming it's deducted from her monthly Social Security check).The local is so independent, they don't care if you sign up with them or find your own insurance to cover the 20% Medicare doesn't pay. 

Honored Contributor
Posts: 12,262
Registered: ‎03-16-2010

Re: You Have To Be Aware Or Get Taken Advantage Of


@KYToby wrote:

I agree it is important to be watchful and vigilant, but I think this is a mischaracterization in regards to the person at the doctor's office.

 

Unfortunately, the insurance coordinators in doctor's offices have to deal with hundreds of different insurance policies as do the insurance companies who issue them.  The practice may have 300 patients with the same insurance company -- each with its own copays, standards, etc.  In this environment, it is easy for mistakes to happen.

 

While it is good that you were vigilant and followed up, please do not let someone's mistake paint her as some schemic, nefarious thief


@KYToby While what you said is true, when you walk into a doctor's office the first thing they want is your insurance card. They then proceed to make a copy of it. If she had looked at the card it said on the front PCP $0 and Spec $0. She did apologize. My mother though would not have caught the mistake and would have been out the $50.

Esteemed Contributor
Posts: 5,312
Registered: ‎03-05-2011

Re: You Have To Be Aware Or Get Taken Advantage Of

[ Edited ]

Well you all will love this:   I worked in Dr's offices for years.  I can tell you they bill for things that are not even done, because Medicare will not pay them enough.  I worked for a General surgeon who's wife was also a Dr.  This little girl in the ER died, and the Dr I worked for was not there. His wife was there as she was a Pediatrician.  She put his name down as being there and seeing this little girl.  I did the billing---So I asked this Dr correct me if I am wrong , but you were if the office this day all day.   He said I know but Jill (his wife) put my name down as a consult.  I got my check and when he left, I walked out and left my keys on his desk with a letter telling him I cannot be a part of this illegal billing.  Now 25 years later, I wish so bad that I had turned him in. 

Honored Contributor
Posts: 10,507
Registered: ‎09-22-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

I have a neighbor (on Medicare) that needed to go to a specialist a couple of years ago.  The specialist she was referred to did not accept Medicare patients because the payment was so low.  

Esteemed Contributor
Posts: 6,813
Registered: ‎05-29-2015

Re: You Have To Be Aware Or Get Taken Advantage Of

It's all so exhausting, isn't it.

 

~~~ I call dibs on the popcorn concession!! ~~~
Trusted Contributor
Posts: 1,177
Registered: ‎07-04-2014

Re: You Have To Be Aware Or Get Taken Advantage Of


@sophiamarie wrote:

I'm so glad we have Medicare and Tricare.  We pay zero, zero and zero.  The only thing that changed is the Rx copay.  That went from $3.00 to $10.00 per monthly script.


Yor are right, but they've found a way around Tricare limitations.  All of the private physicians in the hospital outpatient services building right across the street from the VA hospital joined together to form a service group and the very first thing they did is to refuse to take Tricare patients.  Less than a year later they extended this policy to include Medicare patients as well.  These groups can't be forced to accept us so we're left searching for specialists once again and there are fewer by the day to choose from.

Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of


@jordan2 wrote:

@151949 wrote:

Wow your Mom has an advantage plan with 0 copays?? Who does she have that with?  what is her premium?


She worked and when she retired she was Medicare and had her union local as her secondary insurance. That then changed as the local didn't want to pay for the 20% anymore. They kept changing her insurance plan (I guess to save money for the local) She now has United Healthcare a Senior managed Medicare, it is all inclusive. I believe she pays monthly payments for the insurance ( I'm assuming it's deducted from her monthly Social Security check).The local is so independent, they don't care if you sign up with them or find your own insurance to cover the 20% Medicare doesn't pay. 


I don't exactly understand what you mean by "managed care" That implys a medicare advantage plan to me - but it sounds like she has a supplement because with an advantage plan she would not be using her medicare. Most unions I am aware of put their retirees on an advantage plan as that is way cheaper for them.

Respected Contributor
Posts: 4,354
Registered: ‎03-09-2010

Re: You Have To Be Aware Or Get Taken Advantage Of

My insurance is also very specific about where my blood tests are processed or I get charged.

You need to be careful out there.