[Aloha1]

When we moved to the Villages a year ago, one big reason was the proximity of good health care. Coming from Maui where health care is closer to a 3rd world country, we were hoping to find a good PCP. Then we learned that in order to use TVHC, we would need to buy a UHC supplemental. We are both covered by Medicare AND State of Michigan retiree BCBS supplemental. That insurance is a retirement benefit, covers medical expenses world wide, and costs us nothing. It is a superior plan to UHC, IMO, and we have never had a practitioner or facility not accept it. My hope is that the "powers that be" are potentially rethinking the UHC only decision. What intrigues me is the sentence in the letter that states " improving health care and outcomes for ALL Villages residents". Time will tell.

[Buckeye Bob]

Originally Posted by golfing eagles

First of all, if the insurer approves going out of network, it doesn't matter that Shands doesn't accept UHC MA---that's why they are out of network in the first place---the insurer pays them their usual fee or makes some sort of compromise arrangement.

Second, this is a rather unique treatment that is not available just anywhere---the odds are that the out of network referral would be approved. The only time that it wouldn't be is if there are many specialists in network who do the same procedure and you just WANT this particular doctor/hospital. And even then, in my experience, one phone call from your PCP to the medical director at UHC will get the approval.


Are you STILL ROFLYAO????????

Shands WILL NOT accept the Advantage plan even with the out of network approval or compromise arrangement. No different than the Villages not accepting my supplemental plan.

And yes, I'm still

[xNYer]

Originally Posted by golfing eagles

Here we go again. Must be the heat. Nobody "booted" you, you made a CHOICE, and "booted" yourself.

i have an excellent medicare supplement provided by my employer. As we all know, The Villages health decided that they would only accept that supplemental plan for those under 65.

Technically I made the choice to leave, however it really was a forced choice.

Think of the old Westerns, get out of town now or we shoot you. I guess leaving town is a choice you might make.

[golfing eagles]

Originally Posted by Buckeye Bob

Shands WILL NOT accept the Advantage plan even with the out of network approval or compromise arrangement.

And yes, I'm still

Was I writing in a language other than English? Shands will NOT accept UHC MA. The do not participate in it, if they did they would NOT be out of network!!! And "out of network approval" has nothing to do with Shands, it is a decision made by the insurer as to whether or not they will pay them their asking price or reimburse you. What you are saying is that a patient can show up at Shands, no insurance, but with a boatload of cash , and they won't see him. Unlikely.
Perhaps DB has some insight on how this works from a hospital administrator's point of view.

[golfing eagles]

Originally Posted by xNYer

i have an excellent medicare supplement provided by my employer. As we all know, The Villages health decided that they would only accept that supplemental plan for those under 65.

Technically I made the choice to leave, however it really was a forced choice.

Think of the old Westerns, get out of town now or we shoot you. I guess leaving town is a choice you might make.

Absolutely, and it most likely was the right CHOICE for your situation. Other people made other CHOICES that were right for their situations. My only argument is with those who insist they had NO CHOICE, or that they were "booted".

You made this choice for financial reasons, you did not want to give up a benefit worth thousands. Would you have left if it cost you $10??? $100? $1000? Basically there is a price point for those who left for financial reasons. And that point is different for you and I than it is for Bill Gates or Warren Buffet. Only you can decide what is right for you.

[Dan9871]

Originally Posted by golfing eagles

What you are saying is that a patient can show up at Shands, no insurance, but with a boatload of cash , and they won't see him.

Actually the Shands web site says that a patient who shows up with nothing but a boatload of cash will get a 45% discount on their bill.

[Don Wilson]

My wife and I opted out of the villages system because they would no longer accept medicare and our BC/BS plan F supplement insurances.
We reviewed our choices with someone on the staff that should know (will not divulge who for obvious reasons) and was told if you can afford those coverage's KEEP THEM!

[Boomer]

wow...

Choice? Choice you say? Well, I guess so, but only within the parameters of take it or leave it. Soooo, by pure definition, that's right, I guess, but.......

When I first heard about what TV was doing, by imposing the limitations of only one insurance choice for Medicare-age residents, I could not believe it. I remember asking some guy in a vendor booth at Brownwood the same question, 3 different ways. Basically, my question was, and still is, "Is this for real?"

There are those who claim to be so in the know about the business plans of TV and have the need, for whatever reason, to cling to their defense, even to the point of condescension, as if those of us who dare to question are pizzants. So let's expand the talk about business plans......pizzant though I may be.......

I always thought the basic business concept of TV was to build a place where regular people could have a very nice lifestyle in retirement. Obviously, that concept has been successful, even beyond what could have been imagined in the beginning.

But.......among those retirees who chose to buy in TV, there are many who have retired from the military or from state or federal or municipal jobs or big corporations -- jobs that provided reasonably priced or no-cost health insurance for retirees. Those people worked for a lot of years for good retiree benefits and planned their retirement budgets with the knowledge that healthcare costs were covered.

I feel pretty certain that none of those retirees, who helped to build TV into a huge success, could ever have imagined that the rug would be pulled out from under them by a business decision that smacks of never enough, never ever enough.........

The convenience, or even the possibility, of accessibility is often a very big deal as we age. Now that Medicare-age Villagers have to scramble for outside doctors or give up excellent insurance, accessibility can become more of a factor, especially considering the lack of publicly available transportation. (Anybody remember house calls?)

I have thought from the beginning that this TV insurance business decision was contradictory to the basic business concept of lifestyle in retirement that I thought was TV. TV has made things hard for a lot of people who bought in and made the place such a big success. I think there are many among us who have a perfect right to their ire.

And now, back to the survey. It will be interesting to see where it goes.


Addendum: There is information out there now that says as of 2020, the Plan F Supplement to Medicare will no longer be available unless you already have it. So there we have another possible factor to consider for those who might have given up that one and could be rethinking.

[Buckeye Bob]

Originally Posted by Dan9871

Actually the Shands web site says that a patient who shows up with nothing but a boatload of cash will get a 45% discount on their bill.

Where do you see that on their website?

[Dan9871]

Originally Posted by Buckeye Bob

Where do you see that on their website?

Financial Assistance | Patient & Visitor Guide | UF Health Jacksonville | University of Florida Health

"Uninsured patients who are not eligible for financial assistance under this policy may be eligible for a self-pay discount of 45% off gross charges. Any self-pay or financial assistance discount applied will be reversed if insurance, TPL, a settlement and/or other miscellaneous source is identified"

[Buckeye Bob]

Originally Posted by Dan9871

Financial Assistance | Patient & Visitor Guide | UF Health Jacksonville | University of Florida Health

"Uninsured patients who are not eligible for financial assistance under this policy may be eligible for a self-pay discount of 45% off gross charges. Any self-pay or financial assistance discount applied will be reversed if insurance, TPL, a settlement and/or other miscellaneous source is identified"

The key word in the above is "uninsured patients". Medicare is insurance regardless of your secondary coverage.

[golfing eagles]

Originally Posted by Boomer

wow...

Choice? Choice you say? Well, I guess so, but only within the parameters of take it or leave it. Soooo, by pure definition, that's right, I guess, but.......

When I first heard about what TV was doing, by imposing the limitations of only one insurance choice for Medicare-age residents, I could not believe it. I remember asking some guy in a vendor booth at Brownwood the same question, 3 different ways. Basically, my question was, and still is, "Is this for real?"

There are those who claim to be so in the know about the business plans of TV and have the need, for whatever reason, to cling to their defense, even to the point of condescension, as if those of us who dare to question are pizzants. So let's expand the talk about business plans......pizzant though I may be.......

I always thought the basic business concept of TV was to build a place where regular people could have a very nice lifestyle in retirement. Obviously, that concept has been successful, even beyond what could have been imagined in the beginning.

But.......among those retirees who chose to buy in TV, there are many who have retired from the military or from state or federal or municipal jobs or big corporations -- jobs that provided reasonably priced or no-cost health insurance for retirees. Those people worked for a lot of years for good retiree benefits and planned their retirement budgets with the knowledge that healthcare costs were covered.

I feel pretty certain that none of those retirees, who helped to build TV into a huge success, could ever have imagined that the rug would be pulled out from under them by a business decision that smacks of never enough, never ever enough.........

The convenience, or even the possibility, of accessibility is often a very big deal as we age. Now that Medicare-age Villagers have to scramble for outside doctors or give up excellent insurance, accessibility can become more of a factor, especially considering the lack of publicly available transportation. (Anybody remember house calls?)

I have thought from the beginning that this TV insurance business decision was contradictory to the basic business concept of lifestyle in retirement that I thought was TV. TV has made things hard for a lot of people who bought in and made the place such a big success. I think there are many among us who have a perfect right to their ire.

And now, back to the survey. It will be interesting to see where it goes.


Addendum: There is information out there now that says as of 2020, the Plan F Supplement to Medicare will no longer be available unless you already have it. So there we have another possible factor to consider for those who might have given up that one and could be rethinking.

You make an excellent point. I never said the choices offered were wonderful, just that you HAD a choice. If you are convicted as a serial murderer in Utah, you have the choice of death by hanging, death by firing squad, and death by electrocution. Not very appealing, but nevertheless, a CHOICE.

There was no "condescension" intended, nor are you considered a "pizzant". Anyone can have an opinion as to the meaning of life, or who was our best president, or who makes the best pizza. But if you argue that the pizzeria serves predominantly Ethiopian food, it is no longer an opinion, it is simply factual wrong. If someone points out that this is wrong, it is not "condescension" , it is just setting the facts straight. It doesn't make anyone a "pizzant", just wrong regarding one specific issue. There are specific issues that I have been wrong on as well. I am not the enemy of those who felt slighted by TVH insurance change, just trying to shed some rational light on the subject.

[Dan9871]

Originally Posted by Buckeye Bob

The key word in the above is "uninsured patients". Medicare is insurance regardless of your secondary coverage.

Right but the question was about a person with nothing but boatload of money.

In any case my guess is that they are just trying to prevent double dipping... where your insurance company direct pays you a $1000 for a procedure because that is what the bill said but Shands ends up charging you only $600 after the discount you get when you pay it.

Web sites are usually not a good place to get the real details about things like this. It really something that would require talking with Shands to figure out.

In any case a Medicare Advantage plan has to cover any procedure that is covered by regular Medicare. So if your surgeon was the only one in the area who was qualified to do your procedure (and from what GE said it sounds like that may have been the case) UHC MA would have figure out a way to get him and the hospital paid.

[dbussone]

Originally Posted by OhioBuckeye

I lost all respect for TVH when we first moved here 6 yrs. ago I just had a 5 way heart bypass in Ohio where I lived. It was only 6 weeks afterward that I had an issue in my mouth due to breathing tubes during my heart surgery. I was told never be around people that had any kind of viruses. When I went to the waiting room I sat in there for 5 1/2 hrs. with 3 people having puke buckets for severe cases of the flu. I told the them about it & they said they couldn't do anything about it. (that was their exact words) Then when I did see someone it was a PA & he said I had a cold sore, wrong. We got into see the CEO of the hospital & told her the lot longer story, my $4,000+ dollar bill was forgiven. So Tampa can improve them all they want but if want good health care go somewhere else. Besides TVH can't do anything to your heart, all they can do is stabilize you & send you to another hospital, if you can make it!

I think you may be confusing TVRH (The Villages Regional Hospital) with TVH (The Villages Health) the group of physician practices in various locations around TV. They are not related organizations.


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[golfing eagles]

DB---how does a provider, a hospital, and the insurer deal with reimbursement on an out of network referral????