Talk of The Villages Florida

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-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   Insurance change unaccepted by The Villages Health. (https://www.talkofthevillages.com/forums/medical-health-discussion-94/insurance-change-unaccepted-villages-health-338114/)

bwasman 01-12-2023 08:29 AM

Quote:

Originally Posted by JoMar (Post 2175007)
The Villages Health dropped Aetna plans years ago.....we were one of those that was dropped. Reasons speculated on by residents is that Aetna's payments were slow and always contested, the profit margin was adversely impacted by Aetna and procedures were routinely questioned. Don't know if true or not but The Villages Health is a business so they make their decisions based on business models. We stayed in the system and haven't regretted it.

I'm not certain which system you "stayed" in. The Villages Health or Aetna. Thank you for your input...it was very helpful!

YeOldeCurmudgeon 01-12-2023 08:50 AM

I had problems with Aetna over a grievance. The customer service in the Philippines did their job but the executive office did not. In fact, I believe there is corruption in the ERT (Executive Response Team) based on my experience. I switched to UHC because of that.

Jacob85 01-12-2023 08:53 AM

That happened to us a few years ago. I had to find another doctor. I think it may be because of their billing and it’s so frustrating because we liked our doctors

loweglor 01-12-2023 09:05 AM

Same thing happened to me over a year ago. I liked my PCP at Villages Health but had to change. Not too happy with new PCP but will survive. Aetna has proven to be a little more complicated than UHC to work with. They don't require a PCP and the ones they do have in-network are few and far between. Also, they require prior authorization on many procedures that UHC did not. I have no choice because my husband worked at Pinellas County Government and they made the decision to change whether we liked it or not, no alternative. I would go back to UHC in a minute if they had an affordable plan.

kendi 01-12-2023 09:17 AM

Quote:

Originally Posted by Altavia (Post 2175005)
And that's why you want to stay with standard Medicare if you can afford it...

Last time I checked TV health only takes certain advantage plans and private insurance. So standard Medicare wouldn’t help in this case.

ron32162 01-12-2023 09:22 AM

Sounds like your saying its The Village Health Systems fault. Complain to your Teachers retirement system Maybe they are trying to save money on Health policies, everything is sky high. Welcome to reality its now affecting you.

Singerlady 01-12-2023 09:28 AM

I am also an Illinois retired teacher. Will they not accept you to use them as an out of network doctor? They can refuse to bill the insurance, but you can pay and submit.

Singerlady 01-12-2023 09:30 AM

Maybe, but the State is required to put our insurance out for bid every 3 years.

BrianL99 01-12-2023 09:41 AM

Quote:

Originally Posted by jarodrig (Post 2175099)
The discussion is about PRIMARY CARE doctors.

Specialty Care doctors are not primary care doctors.

Once again , The Villages Health DOES NOT accept standard Medicare ……

My wife and I were kicked out upon reaching 65 and going on Medicare…..

That's not what the original poster asked. For you, it's perhaps about PRIMARY CARE doctors for you, but the OP made a blanket statement that said the Villages Healthcare system doesn't take Medicare. That is untrue.

chrissy2231 01-12-2023 09:56 AM

Quote:

Originally Posted by Ritagoyer (Post 2175085)
But they will run into the same problem they do not except Medicare

I've had Med Advantage for 11 years & LUV it.

chrissy2231 01-12-2023 09:59 AM

Quote:

Originally Posted by BrianL99 (Post 2175094)
Yes they do.

for specialist, not primary

rustyp 01-12-2023 10:03 AM

From The Villages Health website:

"If you are Medicare Eligible, you have an important choice to make about Medicare and the primary care services you receive in this community. The Villages Health is a health care system specifically designed for your lifestyle, but when it comes to Medicare we only partner with a few Medicare Advantage plans."

1. The Villages Health is only one option in TV. Many conventional services that most of you are familiar with "back home" exist here.
2. If you are being provided health insurance through your former employer where you must take the plan your employer provides The Villages Health will not be a very good fit for you.
3. If you are not a fan of advantage plans TV Health is not for you.

Rodneysblue 01-12-2023 10:48 AM

Quote:

Originally Posted by bwasman (Post 2175000)
The Teachers Retirement System in Illinois has replaced United Health Care Medicare Advantage PPO with a new policy contracted with Aetna Medicare Advantage PPO. Use of the new policy has been denied by The Villages Health System and anyone using it has to find new Dr.'s outside The Villages system resulting in delayed care and far out appointments. No reason is given by The Villages System other than a flat No to Aetna personell.

The problem is not with The Villages, it’s with TRSIL. They’re the ones who changed. TVH switched years ago, not just recently.

Burgy 01-12-2023 10:59 AM

"A frequent problem"
 
Quote:

Originally Posted by bwasman (Post 2175116)
I'm not certain which system you "stayed" in. The Villages Health or Aetna. Thank you for your input...it was very helpful!

It seems many people who move to TV bring the retirement "perk" of health insurance which doesn't work well here. If you aren't on Medicare you have to shop around for who and where accepts your plan and many are disappointed with their options. The UHC advantage Medicare plan has seemed to me to be a "perk" for many with The Villages Health primary care offices and a pretty good specialty and hospital network. I doubt many people are better off hanging on to their old employer plan either care or cost wise.

bwasman 01-12-2023 11:14 AM

Agreed. It's always about money.


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