Originally Posted by La lamy (Post 2341048)

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'?

Originally Posted by opinionist (Post 2341126)

My mother had traditional Medicare, but the system failed badly. She had dementia when she fell and broke her hip. She spent 3 days at the hospital before being transferred to a rehab facility, but she was not officially in the hospital for three days. Medicare refused to pay anything for rehab, and her secondary insurance refused to pay anything because of the decision by Medicare. If ever a patient needed a rehab facility, it was my mother. I was forced to pay out of pocket for a month of rehab, and that would not occur with Medicare Advantage.

Originally Posted by CoachKandSportsguy (Post 2341129)

We have friends with denials from MA and Private insurance, had to go to medicare.

The typical MA denial is post injury/operation rehab . . . rehab has a long tail of expenses.

Originally Posted by PugMom (Post 2340957)

it works for me. i've been able to get the care i need, when i need it, for what i want. i've never been denied, never had to sacrifice care. i'm leery of some of these stories, -they appear to be looking for some gut reaction, typically in a sensational way.

Originally Posted by bowlingal (Post 2341067)

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

Originally Posted by bowlingal (Post 2341067)

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

Originally Posted by GoRedSox! (Post 2340947)

I don't think that Medicare Advantage is correctly labeled an experiment, they have been around for over 25 years. Over 50% of all Medicare enrollees are on Medicare Advantage Plans. Most people say they are happy with their MA plan, at least as many as say they are happy with traditional Medicare.

Originally Posted by MSGirl (Post 2341161)

Traditional Medicare doesn’t cover everything either. And there are drs who won’t accept any Medicare. Fortunately in The Villages drs can’t survive without Medicare

Originally Posted by Sandy and Ed (Post 2341157)

I have an MRI diagnosed/confirmed impingement on the sciatic nerve at the L4/5 level. I am not a doctor so I just listen to what I am told. Surgery was recommended. Scheduled but my Medicare Advantage would not approve. Wanted me to do Physical Therapy first!! Huh??? Are they nuts, I thought. Ok. Went to PT. Therapist diagnosed Periformis syndrome. Deep massage on my butt cheek located the muscle and was able to relax its hold on my sciatic nerve. Maybe in this case the denial was warranted?? Again I’m no doctor just a cynical patient. You ask a plumber to check your plumbing ….what are the chances he’ll find something wrong?

Originally Posted by Dusty_Star (Post 2340934)

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

Originally Posted by PugMom (Post 2340957)

it works for me. i've been able to get the care i need, when i need it, for what i want. i've never been denied, never had to sacrifice care. i'm leery of some of these stories, -they appear to be looking for some gut reaction, typically in a sensational way.

Originally Posted by golfing eagles (Post 2341092)

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 :1rotfl::1rotfl::1rotfl:

Originally Posted by Karmanng (Post 2341165)

ALOT of these plans are going to go away and many hospitals are not taking these plans either...........traditional is the only way to go for sure........at least i know they are not going to change my drs on me when they feel like it !!! That happened many times to my folks.........

Originally Posted by MSGirl (Post 2341161)

Traditional Medicare doesn’t cover everything either. And there are drs who won’t accept any Medicare. Fortunately in The Villages drs can’t survive without Medicare

Originally Posted by golfing eagles (Post 2341109)

These numbers are out of date, about 15 years ago, but at the time Medicare budget was $600 billion/year, fraud was estimated at $8 billion/year and the government was spending $12 billion/year to fight it, without success. If that were a private company and you were CEO, what would you do????

The sad part is that it should have only cost 1% of that to find the frauds----just print out a list of the highest Medicare billers that are not institutions and start there. Number one on the list was a Florida solo cardiologist who billed $55 million in one year. Who thinks that was legitimate?????

Really want to cut healthcare cost? Eliminate the continuing practice of defensive medicine that costs over $1 TRILLION/ year by eliminating runaway jury malpractice verdicts (or killing all the lawyers:1rotfl::1rotfl::1rotfl:)

Originally Posted by Joe C. (Post 2341185)

There's a simple fix for Medicare fraud.
1st offense - $1million fine.
2nd offense - $5million fine and 5 years prison
3rd offense - Seizure of all assets and death penalty.

Originally Posted by nancyre (Post 2341058)

BTW there is a BIG difference between a Medicare Advantage HMO & a PPO.

Originally Posted by Karmanng (Post 2341165)

ALOT of these plans are going to go away and many hospitals are not taking these plans either...........traditional is the only way to go for sure........at least i know they are not going to change my drs on me when they feel like it !!! That happened many times to my folks.........

Originally Posted by retiredguy123 (Post 2340939)

Medicare Advantage may be a failed experiment, but so is Traditional Medicare. Medicare fraud is rampant. My mother spent her last 4 months in the hospital or various nursing homes. One medical doctor, who my mother never hired, followed her everywhere she went and billed Medicare for an office visit every day, 7 days per week. She was never hired, and never prescribed any medical treatment. Apparently, she posed as a hospital doctor and got my mother's SSN from her chart. Every day, she would make the rounds visiting her many "patients" in nursing homes and hospitals. Medicare has no checks and balances to determine if a provider was ever even hired by the patient. If they get a bill, they just pay it. At least Medicare Advantage providers have a profit motive to reduce fraud.

The only way to make the system more efficient is to require patients to have "skin in the game" by requiring all patients to pay a copay based on a percentage of the treatment. They need to eliminate free treatments where the patient has no incentive to reduce the cost.

Originally Posted by La lamy (Post 2341048)

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'?

Originally Posted by golfing eagles (Post 2341069)

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.

Originally Posted by LoisR (Post 2341071)

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

Originally Posted by golfing eagles (Post 2341092)

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 :1rotfl::1rotfl::1rotfl:

Originally Posted by Marine1974 (Post 2341202)

What is a Medicare Provider Number (MPN)?

A Medicare/Medicaid Provider Number (MPN) verifies that a provider has been Medicare certified and establishes the type of care the provider can perform. This identifier is a six-digit number. The first two digits specify the state in which the provider is located, and the last four digits indicate the type of facility. For ambulatory surgery centers, the MPN is 10 digits — with the first two digits representing the state where the surgery center is located.

Originally Posted by MSGirl (Post 2341161)

Traditional Medicare doesn’t cover everything either. And there are drs who won’t accept any Medicare. Fortunately in The Villages drs can’t survive without Medicare

Originally Posted by Sandy and Ed (Post 2341164)

Interesting. I had a lung resection due to cancer. Had follow-up treatments with proton therapy (SBRT) four separate times over the years - latest this past March at Moffitt. Aetna Medicare Advantage paid for it.

Originally Posted by Dusty_Star (Post 2340934)

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

Originally Posted by golfing eagles (Post 2341189)

Or even simpler: Yank licenses and prohibit payments from Medicare

Originally Posted by JMintzer (Post 2341231)

Doc,

Like you, I was in practice (I still am, albeit part time) for almost 40 years...

But I'm going to have to disagree with you on this one. If it were a simple "coding error", then the non-advantage plans would also deny the care (which they don't).

We call to get pre-authorization all of the time. They pre-authorize the care, then they deny payment, stating the pre-authorization was never actually a promise to pay.

Now, granted, we've also occasionally had that happen with commercial insurance companies, but it much, much more rare...

Originally Posted by JMintzer (Post 2341252)

I've been investigated by Medicare 4 times. The first time, I owed them about $114.00..

The 2nd time, THEY owed ME about 95.00...

The 3rd time, I owed them about about $34.00. For a grand total of about $50... All of them were simple coding errors...

How many thousands of dollars did the spend to recoup $50?

The last investigation?

They accused me of treating a dead person.

No, I may hav nodded off a time or two in Med school, but I'm pretty sure I was awake during the "How to tell if your patient is ALIVE" lecture!

Turns out, I did a wound care consult on a patient during my lunch hour. Later that evening, around 8-9 pm, the patient coded and died...

I had to go to medical records, dig up the chart and copy the entire day's progress notes, including the vital signs taken in the am, lunch time, my consult, early evening vital signs , as well as the "code blue" event...

I sent it all to Medicare and received a very formal letter that simply said, "Never mind"... No apology, "Oops on our part, sorry for the stress we put you thru..."

It was kinda' like getting a threatening letter from the IRS, when the error was on their part. Not good for the heart!

Originally Posted by JMintzer (Post 2341256)

One other thing to consider is that once you are in an Advantage plan, it can be quite difficult to go back to traditional MC (if that is what you choose to do).

Traditional MC cannot deny coverage for new patients, but those who chose to go with an Advantage plan may have to go thru an underwriting process to re-enroll in traditional MC...

Just food for thought...

Originally Posted by Karmanng (Post 2341170)

those stories are actually true my parents were on the advantage plans and they changed there drs all the time towards the end......I wont go with that plan just because of that plus you cant go to alot of places either with advantge such as mayo clinic...........most hospitals and drs are actually trying to get out of the ma plans fyi