Talk of The Villages Florida

Talk of The Villages Florida (https://www.talkofthevillages.com/forums/)
-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   Wow-TVH temper tantrums (https://www.talkofthevillages.com/forums/medical-health-discussion-94/wow-tvh-temper-tantrums-202430/)

kcrazorbackfan 07-24-2016 08:09 PM

Quote:

Originally Posted by Villageswimmer (Post 1259408)
Whoa! I may have misunderstood this. Are you saying that if you have Fed Govt BSBC you can stay with TVH? Maybe that's why we haven't received the letter. :confused:

Correct....

gage405 07-24-2016 08:15 PM

I have Medicare and Federal BC/BS and I got my letter saying unless I changed by December 31, I am out! Is being on Medicare already the difference?

Carla B 07-24-2016 09:06 PM

Quote:

Originally Posted by gage405 (Post 1259562)
I have Medicare and Federal BC/BS and I got my letter saying unless I changed by December 31, I am out! Is being on Medicare already the difference?

Yes, being on Medicare is the difference. You are not eligible to stay unless you switch to Medicare Advantage (except if you have Tricare for Life and you are already on Medicare + TFL).

Carla B 07-24-2016 09:33 PM

Village Tinker, are you asking about the Benefit Table of the various Medigap plans? If so, you can Google "AARP United Health Care Medigap Plans" and look at what is covered by each plan. I also have the book "Medicare & You" 2016 version that the gov't sends to everyone each year. It explains Medigap plans and also gives a general outline about Medicare Advantage plans. if you would like to borrow it please send a PM.

rubicon 07-25-2016 04:17 AM

Quote:

Originally Posted by goodtimesintv (Post 1259426)
Below are the "Accepted Insurances' at TVHealth. There ARE other insurer's plans accepted.

As I stated above, there is a significant new population here or coming here, who are 55-65 years old, and will not be involved with Medicare for another 7, 8, 9, or 10 years! And if the politicians have their way, newbies under 65 will probably be looking at 70 years old being Medicare age, anyway!

Or, like us, they are still employed and we have employer-based PPO coverage that is in this accepted list.

Note: Medicare enrollees are not the only people living here!

It would be foolish NOT to market to people younger than Medicare age, as they are bringing private insurer dollars in where Medicare reimbursement falls short of operating costs.
Accepted Insurances:

If you are eligible for Medicare, we want you to know that the only Medicare Advantage plans The Villages Health participates in are those offered by UnitedHealthcare®.

UnitedHealthcare® The Villages® MedicareComplete® (HMO) Plan 1
UnitedHealthcare® The Villages® MedicareComplete® (HMO) Plan 2
AARP® Medicare Complete Choice® (Regional PPO)
AARP® Medicare Complete Choice® (HMO)
United Healthcare® Medicare Advantage Dual Complete
We continue to Participate with the following Commercial Insurances:

Avmed
Blue Cross & Blue Shield
Cigna
Multiplan
Private Healthcare System/PHCS
Tricare Standard
United Healthcare
Accepted Insurance by The Villages Health

goodtimesintv: then should i interpret all this to mean someone is practicing age discrimination once a person becomes medicare eligible? Does this mean like that old car what sense is there in putting more money into it to keep it running? Hmmmm

rubicon 07-25-2016 04:38 AM

Quote:

Originally Posted by Polar Bear (Post 1259436)
I agree with much of your post, rubicon. But not this part, stated in such absolute terms.

Corporations exist to make money. And I have no problem with that at all. But corporations are also made up of people.

It may not always happen, but the love can be in both directions.

Polar Bear that profit motive you reference is god to corporation and rightly so. And those nice people you refer to do exist. However its the people who run corporations that matter that control. Have you ever studied what happens when a nice guy (VP) is about to be fired just because he wears hush puppies and does not style himself according to the standard power tie and suit, yet dressed appropriately .And oh he wore braces.

I did and people emptied a room ever time he walked by because they were afraid of contagion and would be fired too. People who broke bread with him daily went to his home, etc. a person who performance wise simply brilliant I could repeat these types of stories over and over again. And that VP with the hush puppies came to me for counseling and to ask for my help.

Knowing I would interfere the president of this company kept me in the dark until it was too late and the matter resolved. because he knew that I would tell hi that he had absolutely no legal basis to fire this VP and he didn't want that on the record. the president and I did have a come to Jesus meeting and of course he had more stripes than me so I knew I was about to go on a suicide mission and used my best Dale Carnegie to no avail/ But this President was too aloof too full of himself ........................

consider also mass layoffs its corporations natural way of survival.

Those nice people you refer to can only be as nice as a corporation will allow. When push comes to shove watch how many remain at your side. Its the human experience So again I say a corporation can't and won't love you back .

Personal Best Regards:

Karron 07-25-2016 04:39 AM

Canada wait time for surgery is REAL!
 
Quote:

Originally Posted by Jayhawk (Post 1258316)
Buffalo Jim isn't far off according to this -

Waiting Your Turn: Wait Times for Health Care in Canada, 2015 Report | Fraser Institute

Specialist physicians surveyed report a median waiting time of 18.3 weeks between referral from a general practitioner and receipt of treatment—slightly longer than the 18.2 week wait reported in 2014. This year’s wait time is 97% longer than in 1993 when it was just 9.3 weeks.

While I was working in Illinois, we had an Orthopedic surgeon who operated on his mother from Canada......at the time he told us that his mother was on a long waiting list because of her age!
Needless to say, she paid cash for hospital care here in the USA, but she recovered and went back home no longer in pain and eventually came back for surgery on the other knee.
Sounds like the "wait time" was real!

jamblu 07-25-2016 06:42 AM

I just enrolled in the UHC Advantage plan because I have M.S. and thought having one doctor would be a good idea for me. I really was not told the negatives. I chose the HMO 2 program. Would anyone explain the differences I might encounter if I need hospitalization or if I need doctors outside of Florida? Are my only options urgent cares under this program?

Villageswimmer 07-25-2016 08:16 AM

Quote:

Originally Posted by Carla B (Post 1259581)
Yes, being on Medicare is the difference. You are not eligible to stay unless you switch to Medicare Advantage (except if you have Tricare for Life and you are already on Medicare + TFL).


They don't mention TFL on the website link posted by Rubicon (thanks R). Wonder why?

The site verbiage isn't clear to me. The second listing should say something like "if you are NOT ON MEDICARE, we accept..."

Am I the only one confused by this?

We still haven't received the letter. We ARE both on original Medicare.

Maybe I need another coffee.

Polar Bear 07-25-2016 08:17 AM

Quote:

Originally Posted by rubicon (Post 1259624)
Polar Bear that profit motive you reference is god to corporation and rightly so. And those nice people you refer to do exist. However its the people who run corporations that matter that control. Have you ever studied what happens when a nice guy (VP) is about to be fired just because he wears hush puppies and does not style himself according to the standard power tie and suit, yet dressed appropriately .And oh he wore braces.

I did and people emptied a room ever time he walked by because they were afraid of contagion and would be fired too. People who broke bread with him daily went to his home, etc. a person who performance wise simply brilliant I could repeat these types of stories over and over again. And that VP with the hush puppies came to me for counseling and to ask for my help.

Knowing I would interfere the president of this company kept me in the dark until it was too late and the matter resolved. because he knew that I would tell hi that he had absolutely no legal basis to fire this VP and he didn't want that on the record. the president and I did have a come to Jesus meeting and of course he had more stripes than me so I knew I was about to go on a suicide mission and used my best Dale Carnegie to no avail/ But this President was too aloof too full of himself ........................

consider also mass layoffs its corporations natural way of survival.

Those nice people you refer to can only be as nice as a corporation will allow. When push comes to shove watch how many remain at your side. Its the human experience So again I say a corporation can't and won't love you back .

Personal Best Regards:

Those are individual experiences and I know many similar ones happen. But they do not describe all of the corporate world.

Sorry...still don't buy your blanket conclusion. :)

Villageswimmer 07-25-2016 08:19 AM

Quote:

Originally Posted by jamblu (Post 1259674)
I just enrolled in the UHC Advantage plan because I have M.S. and thought having one doctor would be a good idea for me. I really was not told the negatives. I chose the HMO 2 program. Would anyone explain the differences I might encounter if I need hospitalization or if I need doctors outside of Florida? Are my only options urgent cares under this program?


I think you should call UHC with your specific questions. This is far too important to rely on responses from a message board. Another good source is SHINE. I would talk with both. Best of luck to you.

dbussone 07-25-2016 10:18 AM

Quote:

Originally Posted by Villageswimmer (Post 1259720)
I think you should call UHC with your specific questions. This is far too important to rely on responses from a message board. Another good source is SHINE. I would talk with both. Best of luck to you.



Excellent and timely advice. [emoji41]

kcrazorbackfan 07-25-2016 02:07 PM

Quote:

Originally Posted by gage405 (Post 1259562)
I have Medicare and Federal BC/BS and I got my letter saying unless I changed by December 31, I am out! Is being on Medicare already the difference?


Correct. I'm 63 and my wife is 56 so we're not eligible for Medicare.

Barefoot 07-25-2016 02:17 PM

Quote:

Originally Posted by HimandMe (Post 1258991)
My kids live in Canada, and this is true. Furthermore, speak to almost any Canadian, they value their healthcare system highly. It's not without fault but better than most but it began 50-60 years ago when perhaps things were simpler and so many others (pharmaceutical, insurance companies etc. etc.) were not making huge amounts off those sick and dying. Another difference is that Canada unlike here has encouraged more general practitioners than specialists. I heard 80-20% with GPs front liners the largest group...and they do more in office). We have a major shortage of GPs to our detriment.
You cannot compare the Canadian system negatively or positively to ours as it's different and has an almost 60 year head start.

Good post.

Quote:

Originally Posted by Karron (Post 1259625)
At the time he told us that his mother was on a long waiting list because of her age!

I know 90 year olds in Canada who are having hip replacement surgery.
Wait times for elective surgery depend on the community and hospital involved.
I just received a knee replacement in a month, and I'm no youngster.
But I had to go to a hospital in Toronto rather than having surgery in the small local hospital.
It's usually all about choices.

wendyquat 07-25-2016 04:12 PM

This answered all my questions!
No Premium "FREE" Medicare Plans | You Get What You Pay For - YouTube

rubicon 07-26-2016 05:46 AM

Not addressed here and the underlying issue for all of this is the affect ACA has had on the health care and health insurance industries. the subject matter is too complex and too political but in a nutshell ACA was passed to create government directed oligopolies and that is what is occurring with the proposed mergers of some health care insurance giants.

Its forcing many changes in pricing, benefits etc. On a practical level how does an ethical doctor respond given the demands made by government and the continuing reduction in fee schedules. My cardio is a guy I respect. He hates that he has to keyboard on his computer to satisfy government/insurance demands when he rather be truly doctoring. I read that medical schools are having a drop in application, especially for primary care physicians . I read that in networks are causing rapid pricing increases of out of network providers. The health care industry has been in continuing flux consolidations, changing medical models ,etc. some physicians are simply doing a cash business providing their patients with the needed billing to return to government/insurance companies ...will it work?

Bottom line is bottom line how do you balance ethical obligations with remaining in business if you are a health care provider?

graciegirl 07-26-2016 08:02 AM

Quote:

Originally Posted by rubicon (Post 1260234)

Bottom line is bottom line how do you balance ethical obligations with remaining in business if you are a health care provider?

And more than that, there is the issue of whether our brightest will continue to choose to go into medicine when they can have a less stressful life and make more money in other areas. The person describing the problems with Canada's social medicine mentions they aren't recruiting enough doctors in Canada.. If you make yourself study and work and commit to a grueling residency for many years after others have graduated and earning a living, it seems right to me that you SHOULD make a lot of money as a skilled doctor.

Now those who are more high minded and maybe more left of me would say, HAH...another money grubber, but I just say it like it is. Socialized medicine discourages medical vocations, and makes medicine less good. It makes people wait for needed procedures, and does not allow them to choose their doctors.

I don't like anything that smacks of socialized medicine, but we both have worked to have good insurance and saved to have money for health needs.

The old Squirrel saving the nuts for the long winter is not pleased with the young ones partying during the nut harvest season. Sacrifices must be made for important issues. If you don't take care of your own family, who is expected to?

We know that answer.


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