Insurance change unaccepted by The Villages Health.
 

The Teachers Retirement System in Illinois has replaced United Health Care Medicare Advantage PPO with a new policy contracted with Aetna Medicare Advantage PPO. Use of the new policy has been denied by The Villages Health System and anyone using it has to find new Dr.'s outside The Villages system resulting in delayed care and far out appointments. No reason is given by The Villages System other than a flat No to Aetna personell.

Bad luck. A victim of Teachers cost cutting likely.

Amazing. My employer did the same…with Aetna also. After one year, we went back to UHC on our own and are very happy. We even save money on premiums every month with very small increases in deductibles. :)

And that's why you want to stay with standard Medicare if you can afford it...

The Villages Health dropped Aetna plans years ago.....we were one of those that was dropped. Reasons speculated on by residents is that Aetna's payments were slow and always contested, the profit margin was adversely impacted by Aetna and procedures were routinely questioned. Don't know if true or not but The Villages Health is a business so they make their decisions based on business models. We stayed in the system and haven't regretted it.

My daughter spent five years in her job battling against Aetna and their refusual to pay claims submitted by her employer, a hospital system. She said they have doctors and lawyers lined up to pick apart contracts and find reasons not to pay claims. And now, the irony is that this year her same employer has contracted to buy health insurance from Aetna.

This what they accept and they've always been clear & upfront about it.

https://thevillageshealth.com/wp-con...-Update-v4.pdf

Even with standard Medicare, you probably still need some type of supplemental insurance. We have basic Federal Employees Health Benefits, with pretty much covers everything Medicare does not. But you have to be a retired Federal employee to get that insurance.

But they will run into the same problem they do not except Medicare

Simple. Aetna doesn’t pay(enough)

Yes they do.

The discussion is about PRIMARY CARE doctors.

Specialty Care doctors are not primary care doctors.

Once again , The Villages Health DOES NOT accept standard Medicare ……

My wife and I were kicked out upon reaching 65 and going on Medicare…..

I am a retired Federal employee and I save thousands of dollars by having the standard Blue Cross plan, but do not have Medicare Part B. The Blue Cross plan covers almost everything I need, and it has a low catastrophic limit of $6,000 per year. The Medicare premiums are too high, especially if you are subject to IRMAA.

Bottom line is employers get an incentive from the new insurance provider. When the contract is up they bid out the business to get another incentive. They have no interest in whether you like it or not.

We have had to change not only primary care but eye Dr, pain management, and where we purchase medications. Hope it is a good company!

I'm not certain which system you "stayed" in. The Villages Health or Aetna. Thank you for your input...it was very helpful!

I had problems with Aetna over a grievance. The customer service in the Philippines did their job but the executive office did not. In fact, I believe there is corruption in the ERT (Executive Response Team) based on my experience. I switched to UHC because of that.

That happened to us a few years ago. I had to find another doctor. I think it may be because of their billing and it’s so frustrating because we liked our doctors

Same thing happened to me over a year ago. I liked my PCP at Villages Health but had to change. Not too happy with new PCP but will survive. Aetna has proven to be a little more complicated than UHC to work with. They don't require a PCP and the ones they do have in-network are few and far between. Also, they require prior authorization on many procedures that UHC did not. I have no choice because my husband worked at Pinellas County Government and they made the decision to change whether we liked it or not, no alternative. I would go back to UHC in a minute if they had an affordable plan.

Last time I checked TV health only takes certain advantage plans and private insurance. So standard Medicare wouldn’t help in this case.

Sounds like your saying its The Village Health Systems fault. Complain to your Teachers retirement system Maybe they are trying to save money on Health policies, everything is sky high. Welcome to reality its now affecting you.

I am also an Illinois retired teacher. Will they not accept you to use them as an out of network doctor? They can refuse to bill the insurance, but you can pay and submit.

Maybe, but the State is required to put our insurance out for bid every 3 years.

That's not what the original poster asked. For you, it's perhaps about PRIMARY CARE doctors for you, but the OP made a blanket statement that said the Villages Healthcare system doesn't take Medicare. That is untrue.

I've had Med Advantage for 11 years & LUV it.

for specialist, not primary

From The Villages Health website:

"If you are Medicare Eligible, you have an important choice to make about Medicare and the primary care services you receive in this community. The Villages Health is a health care system specifically designed for your lifestyle, but when it comes to Medicare we only partner with a few Medicare Advantage plans."

1. The Villages Health is only one option in TV. Many conventional services that most of you are familiar with "back home" exist here.
2. If you are being provided health insurance through your former employer where you must take the plan your employer provides The Villages Health will not be a very good fit for you.
3. If you are not a fan of advantage plans TV Health is not for you.

The problem is not with The Villages, it’s with TRSIL. They’re the ones who changed. TVH switched years ago, not just recently.

"A frequent problem"
 

It seems many people who move to TV bring the retirement "perk" of health insurance which doesn't work well here. If you aren't on Medicare you have to shop around for who and where accepts your plan and many are disappointed with their options. The UHC advantage Medicare plan has seemed to me to be a "perk" for many with The Villages Health primary care offices and a pretty good specialty and hospital network. I doubt many people are better off hanging on to their old employer plan either care or cost wise.

Agreed. It's always about money.

Not saying the Villages are at fault...I am stuck with Aetna and know the retirement system I come from negotiated the new contract. They did say we have identical coverage but did not say Aetna was available at the same places. Thanks for your response.

The highlighted section is correct, AT THEIR SPECIALITY CENTERS, the villages health system DOES NOT accept medicare. I use 2 or 3 village specialists with medicare, I cannot use the villages health for a PCP.

So true. The regular internists are not the same as specialists. At The Villages Health.

INSURANCES can change at any time from year to year ESPCIALLY if they are advantage plans.........FYI

I have Michigan Blue which is identical to Florida Blue. All my bills are run through Florida Blue however The Villages Healthcare will not accept Michigan Blue although they do now accept Florida Blue. It makes no sense.

Now I am confused. This is from their website.

At our Specialty Care Division, we accept most major medical insurance, including Medicare and Medicare Supplement plans.

Medical Specialty Specialist & Services | The Villages Health Florida

The primary care side of the villages health has the advantage plan only rule while the specialty care has a different set of rules as you outlined.

From The Villages Health website:

"If you are Medicare Eligible, you have an important choice to make about Medicare and the primary care services you receive in this community. The Villages Health is a health care system specifically designed for your lifestyle, but when it comes to Medicare we only partner with a few Medicare Advantage plans."

I have had an Aetna Medicare advantage plan through Ohio teachers’ retirement for 12 years and am very pleased. When we moved here 9 years ago, I joined the Villages system. About 15 months later, I was kicked out. Technically, my plan is considered a PPO but because it is from Ohio, there aren’t any in network doctors. That is why mine has an extended service area. That means every doctor and hospital is in network for me. Perhaps the Illinois coverage will be broad like mine is. I hope so.

We wanted to stay with The Villages Health so we switched to United Health. Also, they came out with a new Focus plan this year, we switched to that...co-pays came down and coverages went up.

Not sure what you mean by affordable?