Medicare is also a tough cookie to get to pay .. many doctors fuss about it all the time.. you really need this .... but medicare says otherwise .. currently seeing medicare doing a 5 yr pt audits .. doctors forced to pay back$$$.. guess who is getting the bill.. you are.
just stay healthy ..

Aetna coverage refused for two reasons
 

I am an Illinois State retiree. In the first month of this new Aetna coverage I have experienced delays in pre-certification and refusals . There are two large reasons why Aetna is not widely accepted in TV: poor rates (what Aetna pays) and late payments (up to 6 months to get paid) after services are rendered.

It's always about the money.....the days of actually caring about the patient is most likely over. Doctor's have paperwork up the wazoo....it takes a lot of their time. IF you're not with TVH and complain about long waits and quick contact with dr's at app'ts. This is one of the reasons why. They need to see as many patients as possible to get the $$$$$ they feel they're entitled to. It's become complicated!

I suspect there is corruption at the executive level in Aetna. I ran into a problem with a dentist who was using two names, one for out-of-network listing and the other for his bills, so that he could charge out-of-network prices. I filed a grievance and Aetna rejected it. I filed another and then it went to their executive team (ERT) and the lead person advocated for dentist rather than me who was their subscriber -- obviously, they should be my advocate because they're advocating for the dentist to charge a higher fee and it's costing Aetna more money. In the end, they finally accepted my grievance and I didn't have to pay.

I filed a complaint to HHS and nothing has come of it.

Except for The Villages, I have not encountered any doctors who would not take my insurance. My daughter lives in a Virginia suburb of DC. In her area, fewer and fewer will take any insurance at all. They are adopting the concierge model.

NJ State retiree here. I have Aetna Medicare PPO and have not had a problem, yet. If I need a specialist, I go to their website and put in my zip code and it gives me a list of specialists nearby.

Yes, it is absolutely the fault of The Villages Health primary care to not accept Standard Medicare.

I was stunned to find that my insurance was changed without any prior notifications, with no input from me, just two weeks ago received a new card ???? Called TRS and was told, "Oh, you didn't know ? We've changed companies !" Have not used the villages health care, but am starting this month to explore options for cancelling the TRS insurance completely. Have heard Florida Blue Cross is very good but want to check that out myself, as "very good" to some may be entirely different for the situation of another ! Not really surprised about the Villages H.C. system not accepting, probably not nearly as good as the previous company UHC. If TRS could get poorer coverage but save $$$ they definitely would go for it...Illinois is, after all, flat broke...LOL !

My wife also is retired NJ teacher. The health plan via Aetna Medicare PPO is a state negotiated custom plan only for teachers and is a great plan.
No premiums, $10 doctor copay and I can go to any primary or specialist doctor. All hospital costs covered and they also reimburse us for the Medicare part B premiums.

I guess that's why I was paying all those high taxes in NJ

Bingo ! When I found out my insurance had been changed I expected to get much poorer coverage for more $$$ ! Hope people on here who find desirable options will post the info for others as they find them !

You have not found doctors who reject your coverage ? Do you actually have your Aetna through Illinois TRS ? ?

Question: I "assume" (?) when you dropped your TRS United H.C. plan, of course your monthly premium is no longer taken from your pension check, correct ?

So now that you are paying your monthly rate personally, how much did your rate increase ? If you don't want to say the amount, could you post the percentage ? Just wondering if I cancel my TRS (meaning no group rate advantage), is the percent of increase substantial ?

Thank you for the information, not sure if Illinois will be the same, but definitely will check that out thanks to your experience.

Oh yes, it is definitely the Illinois Teacher's Retirement system, of course they are trying to save money, the state is broke, but... they do NOT provide the insurance, they only allow retirees to purchase as a group and they premiums are taken out of your monthly pension check as a "courtesy". Those who move from the state after retirement must take the preferred provider option, "networks" are not available out of Illinois. So the most interesting and important item will be the difference in monthly premiums by going with another insurance company on our own.

That's the info I'm looking for. Did call UHC or did you seek out an insurance agent here to get the rates, conditions, etc concerning UHC ?