Quote:
Originally Posted by coffeebean
Have any of you had problems with the providers not being in network after you were assured they were in network? I'm referring to any of the Medicare Advantage plans such as United Health Care, Humana and Aetna.
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Yes, quite some time ago before we moved to the Villages we were in an Advantage plan and my wife's doctor sent her to a provider for a prothesis. About two months after the visit we got a bill for about $800 with a statement that coverage was denied because the provider was out of network. She called her doctor about it and in the end the company allowed the claim I guess because her doctor thought the provider was in-network. I forget which company it was.
Two years ago the same prothesis needed replacement and UHC Advantage wanted my wife to travel to a provider in Mt. Dora which is about an hour drive for us.
She found a provider nearby in the Villages that was not in network and would not accept UHC Advantage. She called UHC and told them she didn't want to go all the way to Mt. Dora when there was another provider right nearby... that is no medical need just convenience. UHC said ok, fill out a form. It took only 3 days to get approval. She was able to go to the nearby provider and the provider even took direct payment from UHC.
When we switched to UHC Advantage from regular Medicare, after we had moved to the Villages to stay with Villages Health, my wife's cardiologist became out of network. Nothing could be done about that, we tried, so she had to switch providers. But in the end that worked out really well for us.
The choice between regular vs. Advantage Medicare is a tough one but in the end for us we found Advantage + Villages Health the best choice for us. If Villages Health wasn't around I don't know if we would have gone the Advantage route.