Wellness

[maestra]

@Carmie  THANK YOU!!!!

I used your info on billing and insurance today for DH and his bill (he paid already in person) w/Duke.

I told them I wanted a refund/and he would dispute the charge on his cc. Why? They hadnt submitted/ been denied-just asked him for the payment (if I'd been w/him, this wouldnt have happened).

I told them we wouldnt pay until insurance had denied charge(s) and we saw it on paper (EOB) ; that was our right.

The CSR was very gracious, although taken aback. We will be getting a refund.

I owe this successful ploy to you!

[Carmie]

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@NicksmomESQ wrote:

   Pre existing conditions were covered by The Affordable Care Act until it was dismantled!! It also included no out of pocket yearly exams for everyone.

  I’m not on Medicare but I have friends who are.They get complete annual checkups with no problem & no out of pocket expenses.Maybe it depends on the plan you select.

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For people who go from one insurance plan to another, pre-x doesn't apply.  Senators Kennedy and Kassebaum introduced legislation many years ago that outlawed Pre-X on insurance policies.  Way before the ACA Insurance.

pre-X still could apply to people who do not want to pay for insurance, but when they get seriously sick, they purchase.  For many people Pre-x does not keep insurance from covering their conditions for a lifetime.  It usually last a year or so only.

Medicare has no Pre-x if you choose it when when you are first eligible.  It can apply to people who purchase months or years later....or upgrade their plans.

it is designed to keep people from purchasing insurance after they need it.  Much like having no car  insurance, but purchasing it after you have an accident to get your car fixed.

[RedTop]

My 84 year old mother had her first Medicare wellness visit in January.   It was done by the Family Nurse Practitioner in  her doctors office; took just over an hour and was strictly a basic assessment, and recording pertinent information about Mom’s health issues.   It was not meant to be a hands on physical exam.   Mom is an established patient who sees the doctor every 4 months, so she has regular healthcare checkups.   

Mom has a Living Will, MPOA, and a DNR, which was noted in this assessment.   Mom no longer does any type of cancer screenings, due to the fact she would not treat any condition that might be diagnosed from these tests.   She only agrees to basic labs to check her blood, and thyroid function.   

3 months before the screening, Mom was diagnosed with cognitive issues by her regular doctor.   The FNP did another basic assessment, which Mom failed again, so that was her only issue flagged for follow up.   

The FNP is only in the office one day a week doing the Medicare wellness exams.   Mom is already scheduled for her next one in January 2019.    

[CLHS68]

Medicare never paid for everything & that is why tou need a supplement to pay some of your out of pocket costs.

[pigletsmom]

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@NicksmomESQ wrote:

   Pre existing conditions were covered by The Affordable Care Act until it was dismantled!! It also included no out of pocket yearly exams for everyone.

  I’m not on Medicare but I have friends who are.They get complete annual checkups with no problem & no out of pocket expenses.Maybe it depends on the plan you select.

@NicksmomESQ The ACA hasn't been dismantled. The pre existing is still in place. And for most people that get their insurance through work the pre existing issue doesn't apply.And if you are switching from one job to another pre existing wouldn't be a problem.

Also many states already mandate that pre existing conditions be covered and they did before the ACA. In NY we've had guaranteed issue since the 90's. Too bad no one seems to know that and have been going around thinking they can't get it on the open market.

So if the pre existing conditions part disappears it will basically only touch people that leave a job with health insurance and need to buy on their own. Or if they currenlty buy on their own and there's a change. It would appear to me at this point that this is unlikely to happen.

[NicksmomESQ]

@pigletsmom  I live in New York.My husband was laid off & got another job several years before the ACA. Before he was given medical insurance from his new employer he was required to show evidence of insurability. That included a letter from his prior medical insurer that he & his family members had no pre existing medical conditions going back 5 years.If we had, those conditions wouldn’t have been covered for one year!!        

  Guaranteed issue isn’t worth a darn if it excludes pre existing conditions or raises premiums so high that it’s unaffordable!!

 New York has to work on getting premiums & deductibles lowered.

[hckynut]

I will certainly look at the new plans that will be available and make comparisons with my present coverage. This to me is "I will believe it when I see it" situation. 

Always a lot of talk/words thrown in that many average people can't understand, and who knows, maybe even medical codes only analyst can relate. Fortunately my wife worked as a medical insurance analyst for over 30 years and also still is connected to it through many of her still employed co-workers.

Right now I have no major complaints with my present medical coverage, via Medicare and United Healthcare. While main EOB statements have been "coded incorrectly", the coverage has been satisfactory to me in this high $$$ insurance industry.

hn

[PINKdogWOOD]

Thank you @proudlyfromNJ for more info. I totally didn't get that you do have insurance. Yes my copay is really low too, a bit more for a specialist (and I do see one). I also know everything will be covered one way and then the other, we still do pay for our insurance don't we.

I am not concerned that I'll be 'short-changed' in having the typical tests performed one way or another. I'm irked by this medicare nurse thing in a few ways.

Right off the bat she takes away from me and my Dr talking about how I am. He knows me not this nurse. She's not even authorized to write an order for me to have blood drawn for testing. This blows me away! I have a great Dr who I really enjoy seeing and my annual wellness is pretty much the only time I see him.

I hope I didn't step on your toes.

[PINKdogWOOD]

@wenfen  Wow - thank you for taking the time to write all (or maybe did a copy/paste but who cares!) this is great info for sure! Your last statement really hit home for me about your PCP's practice nixing the medicare nurse thing that basically does nothing for anybody.

Let me add that I did call my Dr's office about this and the person who answered the phone told me that we could see our PCP instead but it would cost us big bucks. I'm going to message my Dr on Monday and have a chat w/him about this. While I am in good health I've made great strides in improvement from one year ago and I really want him to know this and chat about it. Mu husband has had cancer in the past and of course our Dr wants to see him in person. No medicare nurse is going to do anything for either of us.

So yeah, this isn't a done deal for me/us.

[LTT1]

@PINKdogWOOD

Our practice has a Mobile Nurse unit to give wellness exams!

We kept getting a call from them...I don’t remember what it is called, but I don’t want to go there! It looks like a mobil home and is sitting  the doctor’s parking lot.

This must be”reduced health care costs” and to me, it is unwelcome!