There outta' be a law....Medicare plans
 

Just recently my PCP cancelled my appointments because it was decided that patients with my particular Medicare Advantage Plan are no longer being accepted, unless I pay "out of pocket" cost. (For personal and financial reasons I decided not to pay "out of pocket"). This information was not given to me until I called the office one week before my appointment.
I understand a doctor's decision to do this, however, I was not informed by my insurance people, Medicare, or my doctor's office. If I did not happen to call the office I would have shown up for an appointment that no longer existed.
I know I am not the only person this has happened to, so, my question is: "Why can't the doctor's office inform patients when the decision is made to drop those patients who have a particular insurance plan?"
I was told that the responsibility to do this falls on the insurance company. But the insurance company may have tens of thousands of people on their books, leaving the possibility of overlooking someone.
The way I see it, if a doctor can confirm every appointment by texting, why couldn't a simple "FYI" text be sent to patients when their appointments are cancelled because of an insurance decision? (There are some states that require a doctor's office to inform patients with a 60 day notice before any existing appointments are cancelled.)
I know there are a few MD's, as well as insurance folks, on this forum, and I thank them and anyone else who may reply.

Typically, it would be the insurance company who dropped the doctor from their plan. I can understand them not notifying you because they would have no way to know if you had an appointment with that doctor. I think the doctor should have notified you, but a 60 day notice seems unrealistic. They do confirm appointments, but that is usually a few days before the appointment.

What is your particular Medicare Advantage Plan?

But you're not on Medicare, you're under a Advantage plan.
I'm I correct on that?

An advantage plan is Medicare Part C. It replaces and covers most things that Part B (doctor visits and surgery) and Part D (drugs) cover. Part A is hospitalization.

three thoughts....

every insurance company handles things just a little bit different....which makes the work in the medical office more complex... the insurance companies haven't gotten together and agreed upon a standard process....take a guess at how many different insurance companies the office staff has to deal with (add to that the shortage of help)

But standardization within the business world is no surprise...heck, even the hot dog makers and the folks that bake the hot dog buns can't seem to get together and standardize the quantities in their respective packages...how difficult would that be right?

for a practical reason, medical school rarely includes an extensive amount of business courses (that's why many doctors have an office manager)

lastly, yes, a bummer that you were not informed of their decision to no longer accept the coverage you had....but, you still had an appointment on the calendar....the only thing that changed was the method of payment they would accept....you could have paid out of pocket, submitted the claim to your current insurance and switched to one that the doctor accepts

I thank you for your reply, but, as I stated previously, my doctor cancelled my appointments, meaning, I no longer had those appointments. WITHOUT any notification from anyone.
Also, as I previously stated, for personal and financial reasons, I decided NOT to pay out of pocket.

Yes

OP, very sorry this happened to you, and this is one (of many) reasons that we choose to stay with Medicare and supplemental plan. We were on advantage plan for a short period when Villages Health decided to stop grandfathering of supplemental plans. We had some problems and were able to get back to supplemental WITHOUT the underwriting requirement. We will never go back to an advantage plan.

How do Medicare Advantage Plans work? | Medicare

A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

Your appointment was not canceled you were given the opportunity to pay outside the insurance coverage

Not the responsibility of the physicians office.

Medicare advantage plans suck. Only decent if you are healthy. Healthcare is not free. you will be paying somewhere down the line even though they advertise No Premium. Go with traditional medicare. and with the right supplement you have no co-pays, no deductibles, no referrals and it is accepted anywhere in the US. Advantage plans are NOT accepted everywhere.

I have had advantage plans since I turned 65, 14 years ago and have had several surgeries, lots of different medications and appointments with specialists and have paid hardly anything but a small co-pay ($20-35), and no more than a couple hundred for any of the surgeries Advantage plans work very well from my experience.

I find myself in a similar situation. I had Tricare as my primary insurance, which was accepted by Villages Health. Now at 65, my primary becomes Medicare with tricare as a supplement and I am looking for a new doctor because Medicare is not accepted by Villages Health.
I knew this would happen and therefore can't complain, but I do wish I didn't have to change.

I am still a year away, but I have a side question. Can supplement plans be changed annually without underwriting? I know that underwriting is not required initially when reaching age 65.

PS I spent my first 22 years in Allentown

Thanks

Medicare Advantage Plans are great if you want to save money, at the expense of your health.

If your health is your priority and not your wallet, Medicare Supplemental Insurance has much better coverage.

It's always been that way, always will be. Save money or save your life ... you get to choose.

You do know the advantage plans are terrible don’t you? The supplement plans like ‘g’ ‘n’ and others, these are the Cadillac plans for very little money with no copays, $200 deductibles, and I can go to any dr in the country that supports Medicare. My insurance broker told me to never go to an advantage plan and i never will

The question was. Why don’t the Dr call and tell you this. Why is the question and only the Dr have an answer not anyone else. Everything after us naught.

Medicare
 

Wrong wrong. Medicare part c is a supplement from an insurance company ie humana, blue cross etc. It is identified as part E, F, G, M, etc. An Advantage
Plan is total aftermarket coverage from an insurance co. GOVERNMENT Medicare is off the table with an advantage plan. Lower premium with advantage but high deductible and co- pays.

Afraid it's you who is wrong...
 

Plan C is often mistaken with Medicare Part C, also known as Medicare Advantage, but the two are very different. Plan C is supplemental insurance for people who have Original Medicare. Medicare Part C is a private health insurance alternative to Original Medicare.

Not correct. A Medicare Advantage plan is Medicare Part C. Medicare Supplement plans are an additional plan sold to people who have Medicare Part B. A supplement plan will cover most of the 20 percent co-insurance that Part B doesn't cover. Medicare Advantage plans (Part C) are totally different from a Medicare supplement plan, which is also called Medigap.

Correct. Thank you.

The insurance company knows who their doctor is and should notify the person whether they currently have an appointment or not.

Your "broker" makes more money off the traditional supplements. After 30 years in the business, I know that MA Plans are not for everybody, so you have to do YOUR RESEARCH and select a plan that best covers you based on your conditions and your finances. Be aware that these plans can change dramatically every year. Docs and hospitals join and leave insurance plans for a number of reasons annually, but they are obliged to send letters once they change their status. Best of luck to you, OP.

I’ve had a Medicare Advantage plan for years. My State employee pension offers it and only it. It has a low deductible and out of pocket. Since many of us moved out of state, they negotiate the terms quite favorably for us! And, my husband is also on it and the drug costs are unbelievable. My husband’s portion of his old supplemental plan cost more for just him than we’re paying together!
They’re NOT ALL BAD!

Last time the Village Health Care dumped insurance, ALL patients got a letter from VHC. Wether u had that insurance or not. It was an FYI letter. If it didn’t pertain to u then no worries.

Short answer, yes, long answer, contact SHINE, SHINE - Home they have meetings in the villages and provide unbiased information. We have AARP United health care supplemental policies and have had no reason to change. We do tend to change the drug coverage which is a real pain but these change their formularies yearly.
I will send you a PM also.

Many doctors charge if you miss an appointment. You should send him a bill

Yes, it is a shame considering that provider probably had a contract with your insurance company when you renewed your Medicare Advantage plan. Whether they had an obligation to do this or not, the insurance company has a record of your PCP and your agent. There could have been a proactive notice sent to you and the agent. Thank goodness that you checked before you faced an embarrassing moment at check out. Remember to change your PCP of record, when the new one is located, with your insurance company.

A friend was devastated when her Advantage Plan dumped her Doc and hospital half way through her chemo treatments and she was forced to walk away from people she trusted to find new care.

Avoid Advantage Plans
 

This post gives another reason to not enroll in an Advantage plan.

It's easy to be taken in by the TV ads put out by Advantage plans. Everyone wants "free things". You will get a gym membership, a small allowance for dental care and, sometimes, money back.

However, when "the rubber meets the road", Advantage plans are lacking. You will be limited to the doctors and medical groups in the Advantage plan. That seems O.K. until you want to be treated by a particular specialist. The plan will have to provide you with a doctor in the particular speciality you need. However, you have little control over which specialist. If you go to a doctor outside the plan, you will have a fight with the Advantage plan and will have a large co-pay which quickly eats up any savings you made by enrolling in the plan.

In contrast, regular Medicare allows you to be treated by any doctor in a needed specialty who will accept Medicare as payment in full. In The Villages, this means nearly every doctor. It also means that if you want to return to the specialist in your home town who treated you before you moved to TV, you can do so, provided you pay your travel expenses. In effect, you can go to most every doctor anywhere in the country except for the Mayo Clinic which will not accept Medicare. Regular Medicare is one of the best insurance plans available, and, is a relative bargain compared to the benefits it provides.

Before enrolling in an Advantage plan, think long and hard about being starting over with a new specialist, an oncologist or cardiologist, with whom you are not familiar, or returning to the one who has successfully treated you for years.

As Paul Harvey used to say "and now you know the rest of the story"
Why do you think you see all of these Medicare part C plan commercials… And where do you think the money comes from to pay for all of these commercials you see? It's because they are extremely profitable to the insurance company… At the expense of you.
As an investor I have seen their business model. they put a tremendous amount of money into advertisement with the sole purpose of getting as many people on the plan as they can. They then package these as investment portfolios that are bought and sold.
They make it sound very lucrative to the potential buyer of the insurance. They exploit the notion many older people especially those of conservative ilk believe that the government is bad and private industry is good.
These Medicare part C plans everybody seems to think is such a great deal because they have been duped into thinking it saves them so much money. Actually is a borderline scam. They are not concerned at all that physicians will not take them because that is not what they're about. They are all about getting money from you and then turning around and providing the most restrictive coverages they can.

Just another case in point to have a Medicare (Supplement ) Plan like F or G where you have freedom to choose any and all doctors, and are not limited to a small pool of doctors in the Medicare ( Disadvantage ) Plan.

If they cancelled, they have an obligation to inform you just as you do if you cancel.

I'm sorry but I must correct your statement. I'm not sure who you are to speak with such certainty, and while I have due respect for all who may reply to my post, I must tell you that you are incorrect. My appointments were no longer on the books...or...at least that is what I was told.

Every Medicare Advantage Plan has well-publicized co-pay amounts for appointments or procedures provided by doctors or specialists. Usually your appointments with your primary care doctor is free, as long as he is “in network” for your insurance plan. There is always a co-pay for appointments with specialists. But there is also a maximum out-of-pocket amount which caps what you might have to pay each year.

All this information is published and available to people before they sign up for a plan. If you didn’t investigate whether your doctors were in network or out of network, or what the co-pays were, the cause of the problem is your failure to do the research.

But all is not lost. It is never publicized, but Medicare members can change their choice of plans during January through March each year. You are not limited to just the November to early December sign-up period. So you still have almost an entire month to change plans if you so choose. You would be well-served to visit an insurance broker—one not affiliated with a particular company—to have the costs and benefits of various plans explained to you. I’d start with one of The Villages insurance offices. But ask to see a broker. Otherwise you are almost certain to get an agent for United Healthcare.

OP says “… In effect, you can go to most every doctor anywhere in the country except for the Mayo Clinic which will not accept Medicare.…”

This is incorrect. There are quite a number of doctors and hospitals, including most of the very best in the country, which do not accept any of the Medicare plans. Even The Villages Health only accepts the Medicare Advantage plans offered by United Healthcare, Florida Blue and Humana if you are Medicare-eligible.

Yes totally agree! On Advantage plans you can only go to Drs on that plan and hospitals that are on that plan you cannot choose out of their list! I went back to Medicare and UHC because of that reason as I had to travel in order to get certain tests and could not stay with my Cardiologist!

As an Administrator of medical practice for over 25 years I would have my staff call the patients on that plan and give them an option of ash or leave!

If you are required to have a primary care physician, the insurance company would be required to notify you that you need to select a new provider. Otherwise, in our office, we only check benefits a few days before the appointment. Benefits can change on a monthly basis. Patients change appointments all the time. We will check your benefits 3 to 4 days before your appointment. We will then call you to discuss if somthing has changed with your coverage.