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Respected Contributor
Posts: 2,945
Registered: ‎08-12-2013

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

Similar to what happened to me. We've reached our out of pocket because I had major surgery, which means ZERO co pay for the rest of the year.

My physical therapist office was making me pay a co pay until I had to bug them to call my insurance company. Still waiting for my refund. 

Honored Contributor
Posts: 12,113
Registered: ‎03-16-2010

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


@151949 wrote:

@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.


All I know that it was explained as a managed senior care. I was told if a doctor takes Medicare they should take her insurance. The insurance covers healthcare (doctors, hospitals, etc) and also covers her medicines and diabetic supplies. 

Honored Contributor
Posts: 49,761
Registered: ‎03-10-2010

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?


I have an Advantage Plan with 0 co-pays through my employer from whom I retired.  I've been through major surgery and rehab and never paid a penny, so it's possible.  Oh, my only premium is what I pay for Medicare...the usual.

New Mexico☀️Land Of Enchantment
Honored Contributor
Posts: 8,748
Registered: ‎05-13-2010

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

@Sophiamarie  My DH will be signing up for everything Medicare before this year ends.  I'll admit I'm a bit uneasy about this but from all I've heard and a few folks I've talked to, and  your comments here, I become more at ease.  I think it'll be an okay good thing.

 

I'll have one more year on my state retirement insurance plans and then I'll join the Medicare population. 

Respected Contributor
Posts: 3,104
Registered: ‎09-12-2010

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

Back when I used to help my parents deal with their Medicare bills, we rarely had any issues.  It was pretty routine.  Now, I have an aunt who deals with all kinds of hassles.  With all these insurance changes over the last few years it's not only with Medicare, but with our regular insurance coverage as well.  We were warned that Medicare coverage would be cut to accommodate those government plans.  For those who didn't believe it, well here it is.  Think of it this way, your grandchildren voted for you to lose benefits.  Sad, right?

Honored Contributor
Posts: 31,212
Registered: ‎03-09-2010

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

@MacDUFF
Yes, I agree... it IS all so exhausting.... xox
~Have a Kind Heart, Fierce Mind, Brave Spirit~
Honored Contributor
Posts: 31,212
Registered: ‎03-09-2010

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

@jordan2@lulu2

 

Just checking in to see if there has been any clarification of insurance payments, etc.

~Have a Kind Heart, Fierce Mind, Brave Spirit~
Honored Contributor
Posts: 8,420
Registered: ‎03-09-2010

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


@LTT1 wrote:

@jordan2@lulu2

 

Just checking in to see if there has been any clarification of insurance payments, etc.


@LTT1

 

How kind of you to be so caring.

 

The neurologist I WANT to see is the one who does not take secondary insurance.  My second choice is in network. 

 

I called my second choice and the soonest I could get an appointment is 7/11.  I took that appointment.

 

I called the first office to cancel my appointment (which is next week)  The receptionist asked if she could re-schedule my appointment.  I told her about the call I had from the business manager about insurance.  Before she would cancel the appointment she asked me to please let her transfer me to the business office.  The next thing I knew another lady was on the line.  I told her I was canceling an appointment and going with someone in network.

 

She said she was in charge and another person in the office called and didn't explain the situation adequately.

 

They have a contract with Medicare so must accept the negotiated rate they have with Medicare. Medicare will pay 80%.  The 20% balance would be submitted to my secondary insurance and they would pay something on the balance at their out of network rate. Based on their initial consultation and examination fees, I would be responsible for only $20-$35.

 

I want to see this neurologist and need to see one now.  I will not cancel my other appointment until after I see what happens next week.  I could always use it as a second opinion or make the switch completely.

 

Again, thank you for your concern.