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  #11  
Old 12-09-2018, 09:17 AM
rustyp rustyp is offline
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Originally Posted by coffeebean View Post
Thanks to all who have replied. My main concern about the Medicare Advantage plans is the awful reviews hubby and I have read about them. People claim they verified that providers are in network then the insurance companies insist those said providers are NOT in network. I don't know if I can trust the information I receive regarding who is in network and who is not in network.

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.
From a provider standpoint it does not matter which plan. Doctors come and go all the time out of any provider's plan throughout the plan year. Again UHC is the biggest health provider in the USA. Probably a correlation to the most in network Vs size - not sure. As far as your first post some statement that the ins co refuse to pay because of out of network - not likely. Most pay but cost you higher copays (or the difference) due to out of network. Now you need to compare out of pocket maximums to safeguard yourself against that situation. Go to the hospital and ask are you in network. Most likely yes. Now ask is everyone involved in my hospital care in network. You won't get a straight answer to that. I had an emergency visit to TV a few years ago. Hospital in network. Emergency room doctor out of network. Perhaps the emergency room doctor on the previous shift was in network. How are you going to control that ? Bottom line for me is I have TV UHC. The best and easiest insurance I've ever dealt with. The plan works very well here and in New York State when I do my snowbird thing. Love my doctors and specialists.

  #12  
Old 12-09-2018, 09:37 AM
Dan9871 Dan9871 is offline
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Originally Posted by coffeebean View Post

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.
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.
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  #13  
Old 12-09-2018, 09:52 AM
Carla B Carla B is offline
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Just a comment indirectly related. My daughter works for a corporation that handles revenue for large hospital systems. For five years her sole job was to try collect on claims filed with Aetna. They are the worst at paying claims. So I would avoid them.
  #14  
Old 12-09-2018, 10:20 AM
gatorbill1 gatorbill1 is offline
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I don't use TV health, but I do have UHC now after trying some other advantage plans that had very few specialists.
UHC has the most primary care doctors and specialists. Co-pays are a little higher, but no referrals needed for specialists.
Works well for wife and I, no problems with appointments, time with primary care, specialists or procedures needed.
  #15  
Old 12-09-2018, 11:50 AM
capecoralbill capecoralbill is offline
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The trouble is, when you are sick, or in the middle of a crisis , I would not exactly be in the mood to contact United Healthcare, getting forms for the doctor to fill out, and then start petitioning Doctors and waiting 3 days to get an approval for a doctor 50 miles closer . As far as finding out WHO is the network or not , I found it daunting, trying to navigate the United Healthcare website to scroll to the right plan, county, City, for the condition I needed. and even if you do locate one , they have a disclaimer that says their online list might not be up to date. I went back to the Medicare with a supplement , it's not cheap though , it costs me $ 207 per month
  #16  
Old 12-09-2018, 03:04 PM
rustyp rustyp is offline
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Originally Posted by capecoralbill View Post
The trouble is, when you are sick, or in the middle of a crisis , I would not exactly be in the mood to contact United Healthcare, getting forms for the doctor to fill out, and then start petitioning Doctors and waiting 3 days to get an approval for a doctor 50 miles closer . As far as finding out WHO is the network or not , I found it daunting, trying to navigate the United Healthcare website to scroll to the right plan, county, City, for the condition I needed. and even if you do locate one , they have a disclaimer that says their online list might not be up to date. I went back to the Medicare with a supplement , it's not cheap though , it costs me $ 207 per month
Not even close to my experience. When traveling between TV and New York a 2 minute phone call before I leave switches me onto the NY network which then puts me in network there and vice versa. No referrals need for any specialists. Again did this really happen to you or are you relating to something you heard or read about here ?

Last edited by rustyp; 12-09-2018 at 04:16 PM.
  #17  
Old 12-09-2018, 05:43 PM
Dan9871 Dan9871 is offline
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Quote:
Originally Posted by capecoralbill View Post
The trouble is, when you are sick, or in the middle of a crisis , I would not exactly be in the mood to contact United Healthcare, getting forms for the doctor to fill out, and then start petitioning Doctors and waiting 3 days to get an approval for a doctor 50 miles closer . As far as finding out WHO is the network or not , I found it daunting, trying to navigate the United Healthcare website to scroll to the right plan, county, City, for the condition I needed. and even if you do locate one , they have a disclaimer that says their online list might not be up to date. I went back to the Medicare with a supplement , it's not cheap though , it costs me $ 207 per month
This is an over the top description of how UHC Advantage works. We've had a number of major medical crises and UHC Advantage handled them all very well.

Getting a prescription for a prothesis filled is not a crisis.
  #18  
Old 12-09-2018, 05:53 PM
gatorbill1 gatorbill1 is offline
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another thumbs up for uhc
  #19  
Old 12-09-2018, 07:46 PM
queasy27 queasy27 is offline
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OP, I definitely agree with the advice to contact a potential doctor's office directly to confirm that they accept your insurance rather than relying on a published list or even calling the insurance company's help line. The online lists are very unreliable.

While I was researching Medicare, I also made the mistake of speaking to an insurance agent I thought was independent but who works for UH. The entire process was very confusing for me, even after talking to SHINE.

I went with UH Advantage/Villages Health strictly on price; it was about $200/month less than the Medicare supplements I looked at. It has been a bit of a struggle to find specialists here who accept my WellMed UHC plan, but that's partially on me because I wanted to stay with my primary care doctor and don't use the Villages Health system itself.

I've had one instance of UH denying authorization for an MRI and me having to argue about it with them. That happens more frequently with Advantage plans than it does with original Medicare.

Choosing health care involves a bit of predicting the future with regard to what one's health care needs might be.

Best wishes to you.

Last edited by queasy27; 12-09-2018 at 08:53 PM.
  #20  
Old 12-09-2018, 09:49 PM
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manaboutown manaboutown is offline
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Half of the doctors graduated at the bottom half of their medical school classes. I want to be able to choose my doctor, preferably one who went to an excellent medical school in the good old USA and graduated near the top of his class. I also may need one in any one of four states. Thus I choose Medicare plus the UHC supplement.
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