[jnieman]

Originally Posted by retiredguy123

I am very surprised that you encountered an anesthesiologist or doctor in the emergency room who were not preferred providers for the FEP Blue Cross plan. Can you provide their names, so I can avoid them? When I go into a hospital, I always verify that the hospital is a preferred provider, and that the surgeon and the anesthesiologist are also preferred providers. You absolutely have the right to ask and verify this information. But, I have found that almost all competent medical providers accept the FEP Blue Cross as preferred providers and I have not yet found a single provider so far in The Villages who are not. Even the urgent care facilities in The Villages are preferred providers.

For me most recently it was an anesthesologist at the Santa Fe Surgery Center. It also happened to me a couple of years ago at The Villages Hospital. I don't have records of their names. I would have to pull out tax records and sort through bills. The one at Villages hospital was an emergency room doctor.

When I confronted the Santa Fe Surgery center about it they took my name, contacted the doctor then called me back and said to pay the amount Blue Cross paid me and it would be settled. In some cases they will bill you just to see if you will pay it. To me that is preying on seniors. That was not the case for the emergency room visit. It cost me around $600 for that. I had read something recently that this happens across the country at hospitals and that some states are making laws that they can no longer bill you more than what the insurance pays when the doctors are out of network practicing in in-network hospitals. Not sure if Florida has joined those states as of yet.

[retiredguy123]

Originally Posted by jnieman

For me most recently it was an anesthesologist at the Santa Fe Surgery Center. It also happened to me a couple of years ago at The Villages Hospital. I don't have records of their names. I would have to pull out tax records and sort through bills. The one at Villages hospital was an emergency room doctor.

When I confronted the Santa Fe Surgery center about it they took my name, contacted the doctor then called me back and said to pay the amount Blue Cross paid me and it would be settled. In some cases they will bill you just to see if you will pay it. To me that is preying on seniors. That was not the case for the emergency room visit. It cost me around $600 for that. I had read something recently that this happens across the country at hospitals and that some states are making laws that they can no longer bill you more than what the insurance pays when the doctors are out of network practicing in in-network hospitals. Not sure if Florida has joined those states as of yet.

Thanks. I agree that this is preying on seniors. But, I did call The Villages Hospital billing department and they told me that, if you have a scheduled surgery or procedure, you can tell them that you only want to be treated by in-network providers and they will comply. They also said that they do have some out-of-network doctors working in the emergency room, but that it would be extremely rare that they would charge more than the FEP Blue Cross plan because the plan is so highly popular and well recognized. But, personally, unlike some people, I am not at all hesitant about discussing insurance coverage and costs with anyone who is treating me or providing any kind of medical service.

[jnieman]

Originally Posted by retiredguy123

Thanks. I agree that this is preying on seniors. But, I did call The Villages Hospital billing department and they told me that, if you have a scheduled surgery or procedure, you can tell them that you only want to be treated by in-network providers and they will comply. They also said that they do have some out-of-network doctors working in the emergency room, but that it would be extremely rare that they would charge more than the FEP Blue Cross plan because the plan is so highly popular and well recognized. But, personally, unlike some people, I am not at all hesitant about discussing insurance coverage and costs with anyone who is treating me or providing any kind of medical service.

The thing to me that is the most upsetting is that as we age we are not always capable of dealing with insurance issues such as these and know to make that phone call to challenge a bill or ask for an in-network doctor. I know that I have been taken advantage of over the years this way and it won't be happening again.

[klc1923]

Originally Posted by retiredguy123

Thanks. I agree that this is preying on seniors. But, I did call The Villages Hospital billing department and they told me that, if you have a scheduled surgery or procedure, you can tell them that you only want to be treated by in-network providers and they will comply. They also said that they do have some out-of-network doctors working in the emergency room, but that it would be extremely rare that they would charge more than the FEP Blue Cross plan because the plan is so highly popular and well recognized. But, personally, unlike some people, I am not at all hesitant about discussing insurance coverage and costs with anyone who is treating me or providing any kind of medical service.

Last year my husband went to TV ER. We know this is a participating hospital. The one surgeon was not participating - we discovered later when the bill came in. All other providers and facility were participating. In the case of the non participating physician, they can "balance bill" you - the difference between their original bill and the amount they receive from the insurance company. I fought that bill for over a year.

[retiredguy123]

Originally Posted by klc1923

Last year my husband went to TV ER. We know this is a participating hospital. The one surgeon was not participating - we discovered later when the bill came in. All other providers and facility were participating. In the case of the non participating physician, they can "balance bill" you - the difference between their original bill and the amount they receive from the insurance company. I fought that bill for over a year.

I think it is outrageous for the hospital to allow that to happen, and for a doctor to try to rip someone off in the emergency room. It is clearly price gouging. I have never wanted to sue anyone, but this may be an exception.

[vonbork]

Does anyone understand how the military plans play into this? I'm coming from a state where US Family Health is available so I carry Part A of Medicare but not Part B. Moving to The Villages removes this option and as I and my wife are 70 years old and 3 years past my retirement, we'd have to pay a penalty to get Part B, plus our income means we'd be in the higher $250+ a month category plus penalty. I "suspended" my FEHB when I retired so I guess our options are 1) get Medicare Part B plus Tricare for Life as a supplement, 2) use my FEHB plan without Part but with Tricare for Life as a supplement ?

[retiredguy123]

Originally Posted by vonbork

Does anyone understand how the military plans play into this? I'm coming from a state where US Family Health is available so I carry Part A of Medicare but not Part B. Moving to The Villages removes this option and as I and my wife are 70 years old and 3 years past my retirement, we'd have to pay a penalty to get Part B, plus our income means we'd be in the higher $250+ a month category plus penalty. I "suspended" my FEHB when I retired so I guess our options are 1) get Medicare Part B plus Tricare for Life as a supplement, 2) use my FEHB plan without Part but with Tricare for Life as a supplement ?

You may want to consider using the Blue Cross Standard FEHB plan, with the Tricare, and Medicare Part A, which is free. Since turning 65, I have saved almost $10,000 in Medicare Part B premiums by not buying it. Most of what you get for the Medicare Part B is redundant with the Blue Cross, and you can always depend on the $5,000 per person catastrophic Blue Cross annual limit.

[OhioBuckeye]

Originally Posted by klc1923

My husband is retired on disability from his job as a federal employee. He is under age 65 and now is eligible for Medicare next month.

Looking for suggestions/recommendations on which BC/BS plan (standard or basic) works best with Medicare Part B. I realize we can't change plans now, but gathering up facts/info for the upcoming open enrollment season.

thank you

You know even with all the answers here, it's still pretty confusing to know which is better for each individual because everybody lives a different way & wants certian things paid for. So to really answer this question I would think it would be hard to tell someone what the best Ins. plan for them. But it still was interesting to read these comments, thanks!

[GaryKoca]

I am a retired federal employee. I have found that medicare plus Blue Cross basic covers just about everything. I think that Blue Cross standard would be over paying, based on my experience.

[Byte1]

Originally Posted by klc1923

My husband is retired on disability from his job as a federal employee. He is under age 65 and now is eligible for Medicare next month.

Looking for suggestions/recommendations on which BC/BS plan (standard or basic) works best with Medicare Part B. I realize we can't change plans now, but gathering up facts/info for the upcoming open enrollment season.

thank you

If he has BC/BS Federal, why are you going to pay for Medicare B? What does B cover that BC Federal does not?
We have BC/BS federal Basic and like it. Although, we have had problems with Florida Blue mishandling it compared to the state we moved from.
I have Federal BC/BS basic and ONLY Medicare A. We save over $200 a month by NOT having to pay for Medicare B.

[Albrita]

I can tell you one thing for sure! The Medicare Advantage plans are great for people that are relatively healthy! I have some severe health issues! I chose to go with UHC Advantage when in Colorado and thought it was great, with doctors and specialists. Then had Cigna Advantage when I did two years in Texas and again no issues and recommended. However now in Florida the Advantage plans are more costly, have hidden co-pays, limited primary networks, and I even had one specialist call and cancel my appointment after it was set up! Seeing anybody quickly, primary included, has been a nightmare. I can only speak toward one Advantage plan but I went in and compared 5 different companies and found them on the front end, very similar. The one I chose is a 5 star rated so thought I knew what I was doing. So I'm not sure who all determines plans and networks and know that Medicare CMS oversees plans, but I'm not sure who to recommend because it's slim pickens out there for doctors in general once you decide. They have or are consolidated because of payment limitations. I think the state oversight and regulation has a lot to do with it also! Specialists do not want anything to do with pre-existing conditions! Then I found that these companies use retail price to determine the drug donut whole numbers! Not what insurance pays but retail and they are very different. I ran into it because of retail pricing on Advair HFA. I'm thinking original Medicare with a supplement if you can for the 20%, but remember you need part D also. The good news is you can make a change each year! The bad news is there is no guarantee you can get a supplement later on if you don't choose it on the front end. Find an independent insurance agent that wants to help you sort it out! For sure "good luck".

[KenJoan]

I am a retired federal employee. My Wife and I both have Medicare Part B along with BC/BS basic plan. In the last 5 years my wife had 2 new hip replacements and 2 new shoulder replacements. There was no out of pocket expenses, not even for all physical therapy. However, we always find a BC/BS preferred provider. My opinion is that if you go to a preferred provider of BC/BS, which there is never any problem finding, why pay the extra premium for BC/BS standard option when the basic option is so much less.

[retiredguy123]

Originally Posted by KenJoan

I am a retired federal employee. My Wife and I both have Medicare Part B along with BC/BS basic plan. In the last 5 years my wife had 2 new hip replacements and 2 new shoulder replacements. There was no out of pocket expenses, not even for all physical therapy. However, we always find a BC/BS preferred provider. My opinion is that if you go to a preferred provider of BC/BS, which there is never any problem finding, why pay the extra premium for BC/BS standard option when the basic option is so much less.

Your out of pocket expenses are the Medicare Part B premiums. If you do the math, you may find out that you would have spent less money by not having Medicare Part B at all.

[THUNDERCHIEF]

Originally Posted by klc1923

my husband is retired on disability from his job as a federal employee. He is under age 65 and now is eligible for medicare next month.

Looking for suggestions/recommendations on which bc/bs plan (standard or basic) works best with medicare part b. I realize we can't change plans now, but gathering up facts/info for the upcoming open enrollment season.

Thank you

make an appointment in lake sumter landing with united health care, and speak to a rep. They will be very helpful

[HIgolfers]

vonbork- It is my understanding that if you have TRICARE FOR LIFE you must be enrolled in Medicare Parts A and B.

In any event, talk to one of the SHINE reps- they are awesome and are disinterested parties unlike the folks who work at the MEDICARE Stores in the Squares. If you google SHINE and Lake or Sumter county you can find times when SHINE reps are available to speak with you at Rec Centers throughout TV and in community centers/libraries in the surrounding communities. Most of them are available on a walk in basis.