[RICH1]

I have an F PLAN with a Part D plan... when you get really sick and your Advantage Plan lets you down, you will regret your choice.., TALK TO A HOSPITAL BILLING ADMINISTRATOR

[RICH1]

Originally Posted by Sabella

Medicare advantage plans are very good but the older you get and the sicker you get and the more medical care you need that’s when they’re not good and a lot of things get denied that you would’ve had with original Medicare.

Yes, it happened to my brother....

[bowlingal]

LaLamy, yes it's true. A friend who has Medicre Advantage was denied a nuclear test. If they had a traditional they would have been covered, no problem. So, just because you never heard of it, doesn't make your statement true. The advantage plan is good as long as you don't get sick. But, no one knows when you will get sick.....and you will get sick

[golfing eagles]

Originally Posted by La lamy

I've never heard of medicare advantage patient being delayed or denied care. I've seen a lot of lives saved through quick emergency response or months of various treatments to fight cancer successfully. Does the OP have an agenda for spreading this 'info'?

Absolutely, positively 100% agree. The OP is nonsense, as is the "list" of "denials" a few posts above.

Do insurance companies occasionally deny requests for certain tests, treatments, hospitals or specialists---you bet they do. Advantage plans do, Medicare supplement plans do, private insurance does. ALL insurance plans have a set of policies and approved services. Most denials are simply because the service was not "coded" properly, others because the service might be new or considered experimental. HMOs and PPOs have a panel of approved physicians that are agreed upon by the insured when they choose that plan---it is the patient's decision. You need approval to go "out of network" or undergo a procedure that is not on the approved list. However, even with those restrictions, 99% of the time one phone call from your physician to the medical director of the insurance plan will get you approval. But that request must be medically necessary---whining that you want hospital A or physician B because your cousin's barber liked them won't do, nor should it.

Can one go on the internet and harvest a bunch of medical "horror stories"??? In a country of 330 million, no problem, since those who feel "wronged" are the first and loudest to complain. I can also find legal horror stories, automotive horror stories, daycare horror stories, and ditch digger horror stories. If someone is looking for 100% perfection in any system, might I suggest the planet Utopia?

Do you want to glean populist support? Just claim that the big, bad CEOs are making a fortune by cheating, conniving, deceiving and exploiting their workers, or the taxpayer, or the government. Readers will eat that crap up. The same readers that will pay thousands to see some guys kick a ball around a field or hear some rap crap guy "sing".

I don't know if the OP has an "agenda", but just add my wife and I to the millions that chose an advantage plan and are happy. And as many of you know I am familiar with medical insurance.

[LoisR]

Nonsense. Just have the patient sign a doctor's visitation statement.

[Marmaduke]

Originally Posted by La lamy

I've never heard of medicare advantage patient being delayed or denied care. I've seen a lot of lives saved through quick emergency response or months of various treatments to fight cancer successfully. Does the OP have an agenda for spreading this 'info'?

I've heard of many funky differences. Here's just one:

Our next door neighbor moved in and began pickleball lessons as soon as she landed.

She began practicing and then playing everyday.
Within the 1st months of play, she fell backwards and got very hurt.
Rushed to the E.R., she learned of several breaks to her elbow and needed surgery.
She is on Medicare Advantage.

She had to wait for TEN DAYS before it was approved. She was in excrusiating pain, but was given opioids to aid her.

Everyone was shocked and didn't understand. She and her husband said it was due to their Medicare Advantage Plan.
Glad we're not on that.

[R&J in NJ]

Medicare Advantage plans are good until you get really sick. Then you require specialists but the best ones are not in your plan.

[ehonour]

Originally Posted by La lamy

I've never heard of medicare advantage patient being delayed or denied care. I've seen a lot of lives saved through quick emergency response or months of various treatments to fight cancer successfully. Does the OP have an agenda for spreading this 'info'?

Delays and denials are happening frequently. I had a urine test for an infection following surgery. The doctor's office had the ability to do the test immediately in their office. Florida Blue required instead they send the test to another agency. As a result, I went through a weekend of continued agony before we could get the results and prescribe something.

A good friend this year waited FOUR MONTHS to get approval for a CANCER medication.

These two are personally known. You can easily find many, many more.

[Sandy and Ed]

Not failed. But no real oversight. HCFA (healthcare finance administration), as is most government agencies,is a bureaucratic mess. Just get “someone” in power to clean up these oversight agencies and get people to do the job they are being paid to do. Pay bonuses to employees that report fraud and abuse. Start putting people in jail. If this was another country there would be executions!!!

[golfing eagles]

Originally Posted by ehonour

Delays and denials are happening frequently. I had a urine test for an infection following surgery. The doctor's office had the ability to do the test immediately in their office. Florida Blue required instead they send the test to another agency. As a result, I went through a weekend of continued agony before we could get the results and prescribe something.

A good friend this year waited FOUR MONTHS to get approval for a CANCER medication.

These two are personally known. You can easily find many, many more.

To the extent that made sense, your urinary infection weekend is on your doctor, not the insurance plan. The proper medical procedure for a presumptive UTI is to treat empirically with antibiotics pending the result of the urine culture. It takes 2 days to grow out a culture, no physicians office is equipped to grow cultures, and if he bothered to have so much as a child's toy microscope he could have looked at the urine sample to determine if excess WBSs were present. Place the blame where it belongs.

As far as "4 months to get chemo drugs" goes, Neither of know, but I suspect that the oncologist chose a treatment protocol or chemotherapeutic agents that fell outside of the mainstream. But like I said above, it's easy to find horror stories. I also suspect the same delay would have occurred with traditional Medicare or private insurance.

[MX rider]

Originally Posted by golfing eagles

Absolutely, positively 100% agree. The OP is nonsense, as is the "list" of "denials" a few posts above.

Do insurance companies occasionally deny requests for certain tests, treatments, hospitals or specialists---you bet they do. Advantage plans do, Medicare supplement plans do, private insurance does. ALL insurance plans have a set of policies and approved services. Most denials are simply because the service was not "coded" properly, others because the service might be new or considered experimental. HMOs and PPOs have a panel of approved physicians that are agreed upon by the insured when they choose that plan---it is the patient's decision. You need approval to go "out of network" or undergo a procedure that is not on the approved list. However, even with those restrictions, 99% of the time one phone call from your physician to the medical director of the insurance plan will get you approval. But that request must be medically necessary---whining that you want hospital A or physician B because your cousin's barber liked them won't do, nor should it.

Can one go on the internet and harvest a bunch of medical "horror stories"??? In a country of 330 million, no problem, since those who feel "wronged" are the first and loudest to complain. I can also find legal horror stories, automotive horror stories, daycare horror stories, and ditch digger horror stories. If someone is looking for 100% perfection in any system, might I suggest the planet Utopia?

Do you want to glean populist support? Just claim that the big, bad CEOs are making a fortune by cheating, conniving, deceiving and exploiting their workers, or the taxpayer, or the government. Readers will eat that crap up. The same readers that will pay thousands to see some guys kick a ball around a field or hear some rap crap guy "sing".

I don't know if the OP has an "agenda", but just add my wife and I to the millions that chose an advantage plan and are happy. And as many of you know I am familiar with medical insurance.

Very well said! We're on UHC Advantage and like it.

Yes, there will always be "horror stories" as you pointed out. But MA plans vary, and some are better than others for sure. People need to do the research and make an informed decison.

Having a choice is a good thing, one size does not fit all.
Over 50% of new medicare enrollees chose MA plans. If they were so bad they wouldn't be so popular.

Btw, we really like the wellness and vision benefits. We get free membership to Genesis gym as a side benefit. Very nice place. My wife takes 2 fitness classes a day there 6 days a week.

[golfing eagles]

Originally Posted by Sandy and Ed

Not failed. But no real oversight. HCFA (healthcare finance administration), as is most government agencies,is a bureaucratic mess. Just get “someone” in power to clean up these oversight agencies and get people to do the job they are being paid to do. Pay bonuses to employees that report fraud and abuse. Start putting people in jail. If this was another country there would be executions!!!

Please, please, please make ME the "someone" in power as appointed dictator. I'll fix it in under a year. Of course, I'd also have to disband Congress, rewrite some laws, possibly including the constitution, kill all lobbyists and execute those who propagate ridiculous tripe online. Probably not going to happen

[pendi99]

Originally Posted by Dusty_Star

Some say that Medicare Advantage is a failed experiment. Patients get delayed & denied care, the taxpayers are paying mightily for the winners: the insurance company executives. They also say it should be discontinued or dramatically reformed.

MA was sold heavily to Congress by insurance company lobbyists on the basis that it would save money over traditional Medicare.

Is Medicare Advantage a Failed Experiment? Experts Debate - MedCity News

Sounds like sour grapes due to a poor experience? Advantage companies negotiate rates w a small closed group of providers. Trying to go outside the group becomes very expensive. Pick the right plan for providers you want to use.

[MX rider]

Originally Posted by pendi99

Sounds like sour grapes due to a poor experience? Advantage companies negotiate rates w a small closed group of providers. Trying to go outside the group becomes very expensive. Pick the right plan for providers you want to use.

Our MA plan actually has a very large, nationwide group of providers. Before we signed up we checked here in Indiana. 90% of the hosptals we checked took it. So did the medical group we use.

[retiredguy123]

Originally Posted by Sandy and Ed

Not failed. But no real oversight. HCFA (healthcare finance administration), as is most government agencies,is a bureaucratic mess. Just get “someone” in power to clean up these oversight agencies and get people to do the job they are being paid to do. Pay bonuses to employees that report fraud and abuse. Start putting people in jail. If this was another country there would be executions!!!

I mostly agree, but paying bonuses to employees will be wasting even more money. Medicare fraud and abuse are so rampant, that reporting it will do nothing. The people in charge know it exists, but they just don't care. I laugh every time I see a TV ad asking for the public to report Medicare fraud. This is just a publicity stunt to make people think the Government is trying to reduce fraud. If you report it, they already know about it, but they have no way to stop it anyway.