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Esteemed Contributor
Posts: 6,980
Registered: ‎03-05-2011

Re: Question for Medicare People

@sfnative  How the heck do they make more money off of an advantage plan?   THat makees no sense. 

Esteemed Contributor
Posts: 6,980
Registered: ‎03-05-2011

Re: Question for Medicare People

[ Edited ]

@151949  I had some issues many years ago.  I was having chest pain.  My EKG showed nothing was wrong and the DR sent me home.  I ended up in the ER and the problem was they had me on way too much thyroid meds.   THey told me if something isn't happening in that minute that that is connected , it won't show.

  

 

I am not into all this preventative stuff.  I have spent too much of my life sitting in Dr offices either with my issues or my hubbys.  He is now gone and I am healthy.   I am not going to spend  time sitting in Dr offices when I have nothing wrong.

 

United Healthcare said it is offered YOU DO NOT HAVE TO DO IT----It is the Dr,s that get a good grade for pulling you in there. 

 

I know so many people that went faithfully for physicals every year and died in between visits.  They cannot detect everything.   In fact there is a lot that they cannot detect.  I Know I worked for Internal Dr's.    

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

Re: Question for Medicare People


@BalletBabe wrote:

@sfnative  How the heck do they make more money off of an advantage plan?   THat makees no sense. 


 

 

They don't. It's a bunch of baloney.

Esteemed Contributor
Posts: 5,258
Registered: ‎03-10-2010

Re: Question for Medicare People

@BalletBabe

 

There is only so much information available online and most of that is "click here to purchase a plan" type of information.

 

Medicare Advantage is like Medicare Plan C.  The only thing I can make of this, and I could be absolutely and entirely incorrect, is that the doc's office bills Medicare Advantage, gets paid, may or may not pass the remaining balance onto the patient, then write-off the balance.

 

With my combo, Medicare and a really buff private insurance PPO, the doc gets paid by Medicare, then my private insurance picks up and pays whatever Medicare did not pay.  From my perspective, this sounds like a good deal.  However, all Internal Medicine offices but one, take only Medicare Advantage, but none could or would tell me why, so bottom line is that I'm unable to answer your question.

 

There may be someone out there who works in a physician's practice at the billing end who could.  Hope such a person reads this and chimes in.

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

Re: Question for Medicare People

If you are having an arrythmia issue it would have to be occuring at the time you are on the machine but if you are having or have had a heart attack the result will remain on the EKG. In the hands of the right person to read it - a cardiologist , not an ER doc - an EKG is a wealth of information.Some med professionals can only see the obvious but a good cardiologist picks up all the subtle changes. I bet thousands of times I have missed something on my patient's EKG but when the cardiologist shows up they pick it right out and show it to you. AND THAT IS WHY THEY MAKE THE BIG BUCKS.

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

Re: Question for Medicare People

@sfnative  -- When a doctor sees a medicare patient or a medicare advantage plan patient they get the same amount of money.  With medicare they pay 80% and the patient has to pay the other 20%. Most patients have a supplement that pays it. When an advantage plan patient sees a doctor they have a copay that they have to pay. For me the co pay for my PCP is $10. I pay that before I leave the office, they bill my insurance and get paid the remainder from them.

So for a $100 office visit - a medicare patient's medicare will pay $80 and their supplement will pay all or part of the remaining $20.Whatever is not paid would be up to the patient. For an advantage plan patient - the patient would pay the copay - say $10 then the insurance pays the additional $90.

I bet the problem you had finding a doctor was they did not want to deal with the company that you have as a supplement.

Esteemed Contributor
Posts: 6,980
Registered: ‎03-05-2011

Re: Question for Medicare People


@CelticCrafter wrote:

@Q4u wrote:

@BalletBabe wrote:

What is the purpose of this Welcome to Medicare exam.   Seriously???

 


"The "Welcome to Medicare" physical exam is a one-time, preventive physical exam Medicare covers within the first 12 months that you have Medicare Part B. The visit will include a thorough review of your health, along with education and counseling about the preventive services you need, like certain screenings, shots, ..."

 

https://www.medicare.gov/people-like-me/new-to-medicare/welcome-to-medicare-visit.html

 

It's just a general evaluation/physical exam by your doctor that is fully covered by Medicare.... kind of like a baseline evaluation at the time you're starting Medicare.  No biggee and you're probably getting a yearly exam anyway....  Woman LOL 


What a waste of time and money since a PCP would have all this information already.


Exactly, and that is why I am not going to do it.   It is an invasion of my privacy as far as I am concerned.  I was told they ask a couple pages of questions?   Sorry but I have better things to do then go to an appointment that I don't need.   The more I think about it , the angrier I get.  

Honored Contributor
Posts: 15,344
Registered: ‎05-01-2010

Re: Question for Medicare People

I never did the Welcome thing. I just ignored it. No big deal.

Esteemed Contributor
Posts: 6,980
Registered: ‎03-05-2011

Re: Question for Medicare People

@CelticCrafter  I am wondering if they cannot give all of your family history etc. unless you do this?   Like you said he has all this information.  Is this a way for the Government tto intrude in our business???   They can find out when they get my bills what I have.  LOL

Esteemed Contributor
Posts: 6,980
Registered: ‎03-05-2011

Re: Question for Medicare People

@proudlyfromNJ  Well that sounds easy, but when your Dr is basically saying that he gets a good grade for doing it , it puts pressure on me.  I don't appreciate that.   Or is it th Clinic that he is in that wants it?   $$$$$$$$$$