Problem with Devoted Medicare PPO - where to get help
 

Does any member here know of any usable Florida agency that will help a senior with a medicare advantage company issue ?

Devoted PPO plan promotes a wellness bucks benefit and then company bails on providing the benefit.

This is monies we need not have spent if we knew in advance we were gonna get stiffed.

I don't want run-arounds from wasteful Florida agencies. Many do nothing or try to sell you other crap.

This qualifies as 'senior abuse' by the medicare provider.

You can try Senors against crime and the BBB, I am sure Florida has a health care advocate, so try your local state representative to get a contact and file a complaint there also.
If (BIG IF) you have not been in the advantage plan for a year you should be able to get back to traditional Medicare without underwriting, we managed to do this when we found out that we could not get the care we needed under advantage plan.

I would contact Shine, they might be able to direct you

What is Shine ? Never heard of them ?

SHINE (Serving Health Insurance Needs of Elders) is a free program offered by the Florida Department of Elder Affairs and your local Area Agency on Aging. Specially trained volunteers can assist you with your Medicare, Medicaid, and health insurance questions by providing one-on-one counseling and information. SHINE services are free, unbiased, and confidential.

I was told by my PCP doctor to use ...
1 800 96 ELDER what a waste -- all they tried to do was sign me up for the medicaid welfare stuff that I refuse.
They referred me elsewhere that had a disconnected phone number
Dead Ends they all are so far.
Which is sort of elder abuse in itself.

I did a search (Bing) "how to file a complaint against a medicare advantage plan" and found several possible avenues to pursue, but it appears that if you file a complaint with Medicare the advantage plans has 30 days to respond. You could also try one of the local (orlando) television stations they seem to love investigating these types of problems, and of course the insurer will get a lot of negative press.

As a licensed nurse in FL, I’ll tell you what we tell our 65+ patients…go to Welcome to Medicare | Medicare. They have a questionnaire that you will plug in your meds, diagnoses, where you live, etc & come up with multiple options for you. There are companies who are reputable & get paid by the insurance companies when they get a referral, not you, but don’t push 1 insurance over another. I just have not dealt with them in this area, only in Jacksonville. Hope this helps.

maybe talk to the people at SHINE. they are Medicare people that may be able to help you. They meet at several rec centers here in the villages and Lady Lake Library. Different days and times. Eisenhower rec center 9-11:30 1st and 3rd Wed. Chula Vista rec center 3-5:30 1st and 3rd Fridays. Lake Miona rec center 9-11:30 2nd and 4th Tuesdays. Lady Lake Library 2-3:30 2nd and 4th Wednesdays. For more information 1-800-963-5337

SHINE, absolutely in their ballpark.

Sorry if you got "stiffed", but I have a few questions:

Which Advantage plan is this?
How many $$$ are we talking about?
Did you buy an insurance plan or "wellness benefits"
Was there any "fine print" about what you are and are not entitled to?

Regardless, this is a most likely a miniscule amount of $$$ and I certainly wouldn't refer to it as "elder abuse". If you really want to know what elder abuse actually looks like, I can take you to nursing homes and show you. Thank God you are not one of those that are truly abused.

From your original post, it sounds like you bought stuff then tried to get reimbursed. If so, that’s not how the benefit works. When you make qualified purchases, you use you benefit card to pay for them and pay for the balance of your purchases.

We saw a YouTube video done by Rusty Nelson on this subject with Crystal Andrus. He explained his journey in deciding Medicare vs Medicare Advantage Plan and how much help Crystal Andrus, CLTC - Insurance Broker, Sphere Coverage Solutions, Inc., Affordable Health & Life Insurance Plans in Florida & Beyond- Sphere Coverage Solutions, Office: (352) 801-7232.

I called her and she was extremely helpful in deciding which way I should go upon retirement. She looked at my meds, what services I may need and where, and I ultimately went with an Advantage Plan that was flexible enough to see my doctors in TV and NY and having them "in-network" regardless of where I am. She has answered questions both before and after signing up. I would give her a call to discuss your situation, and while she may not be able to "fix" the company you are currently with, she may be able to guide you in resolution or even changing companies.

Wait till you get older
 

Wait till you get older and as we get older and we age, it’s sad to say but we do get sicker and more medical issues. Your advantage plan might be great now, but as I said, as you get older and you have more issues you’re going to regret that you didn’t stick with original Medicare.

And just what are those "issues", specifically, that you feel will be a problem with an Advantage plan as opposed to Medicare with a supplement? The only one I can think of is electing to have a procedure out of network that is also available in network----and that choice would be on the insured.

The biggest issue with advantage plans are rehab issues.
From people who have had those plans, they are fine, until post op rehab starts, then they have issues. And this is from a career nurse who worked in both clinical and administrative, both non profit and profit. . who has ****loads of questionable MD and insurance observed experiences.

My late wife had an advantage plan and had we had no issues with a rehab stay at Freedom Point of about 3 weeks.

This is what we did and it was helpful to a point. My main concern was getting coverage for my $17,000 per month tier 5 specialty drug. The sight gave me pharmacies for my specific medication in my area and what I would be paying only to find out later that none of these pharmacies can actually get my meds. Even their specialty drug department couldn’t get it. Very misleading and frustrating.

Via benefits provided me with the best plan D options to go with and explained each in detail. Then finally the insurance carrier I chose gave me the info I needed as to how and where to get my meds

The process took a lot of research, calls and actually walking into various pharmacies before I finally was able to get the issue solved. I’d be up a creek if I had relied solely on the information provided by the government on this website you suggest.

I know people who did have issues there. Probably depends on the specific situation.

sample 1, you know better than that for statistics.
Also well documented with studies in MA I have a source with multiple samples in multiple settings. . and have posted independently documented issues in MA from actual practitioners, which is resulting in proposed state level intervention.

Also have an admin insider (CoachK who is in charge of all hospital system regulatory reporting) with MA data samples, causing many hospital issues.

checkmate

Premature death is one such problem. A friend couldn’t get the proper care needed because the advantage plan would not pay for the medical facility she needed to go to to get the specialty care needed. This person died as a result.

On the upside, a relative of mine with lots of medical issues has an advantage plan that has been great for her. She lives in a state where the healthcare is excellent and the hospital system she is in is covered by her plan. And this system provides top notch care for just about any condition you can think of.

A lot of assumption there. Depends on her illness, its severity, the definition of the care she would have gotten at the "medical facility she "needed" to go to" vs the care provided in-network and that her death was a direct result of not being at one specific facility as opposed to the underlying pathology. Sorry for your loss, but it may be a case of post hoc ergo propter hoc.

And as chairman of QA, I would have been in charge of the work CoachK did.

un-checkmate :1rotfl::1rotfl::1rotfl:

Advantage plans are the worst, I don’t care which 1 you pick. They are ran by insurance companies and the way they make money is to deny service, I read they deny service almost 70% of the time. Congress is looking at this because Medicare does not deny any service. The insurance companies hope you stop at this point and not get the help done, so they save. You can get your Dr to fight them and maybe they will cave in but a lot of the time they don’t. So you have to ask yourself, if Medicare doesn’t deny you medical service, why should an advantage plan deny you?
There are many other benefits that a plan g/n/or any other supplement plan out there provides over an advantage plan.

We got fed up and kicked Dis-Advantage down the road. Go get peace of mind by losing the brain damage when you get into Medicare Supplement G.

We have had an advantage plan for the 4 1/2 years we have been here and working very well for us.

Does help that personal physician does a very good job for us in getting approvals

And to quote Luke Skywalker from Star Wars ep.8, "Everything in that post is wrong"

Medicare doesn't deny any service???? :1rotfl::1rotfl::1rotfl: I wish. Unfortunately we had several FTEs just to fight Medicare denials. I can't count the number of times I had to personally speak with the physician at the Medicare intermediary to get a simple CT or MRI for a patient that needed it.

They don't cave in if the physician fights for it???? Maybe I'm lucky, but I ran 100% at getting Medicare to approve once I spoke with them.

Advantage plans "deny service"???? No, they limit choices by restricting services to networks. These networks are generally large and diverse enough to handle 99.9% of patient needs.

Deny 70% of the time? :1rotfl::1rotfl::1rotfl: I would guesstimate, based on 35+ years' experience that it is about 5-10%--but even that percentage is huge given the volume of orders.

And finally, you should realize that when Medicare denies a service, both advantage plans and supplemental plans alike will deny service as well. The best way to fight either is to have the physician make the necessary phone call. Unfortunately, most doctors these days seem more interested in maximizing billing and consider following up on denials as a waste of time.

And finally, from a patient's perspective, my late wife had an advantage plan----ZERO denials
My current wife has an advantage plan---ZERO denials
I have an advantage plan---ZERO denials

Now, does anyone think that with my knowledge and experience I would sign up for a plan that is "the worst"????? There are some cost saving with and advantage plan, but trust me, I couldn't care less about that.

Those that are critical of advantage plans have either experienced or more likely heard of the one-off problems. Americans, (me included) are generally whiners who want what they want when they want it. Many will sign up for an advantage plan for the monetary savings and then scream bloody murder when they can't see the Chief of Cardiology at Massachusetts General Hospital. But if anyone can't find a physician among the 175,000 that are in the Florida Blue network I can't help them

Of course, these plans aren't for everyone. If you have significant chronic health conditions and are already seeing specialists that would fall out of network, go with a traditional supplement. But if you are relatively healthy, the chances of getting a condition that cannot be adequately handled with a BC/BS or UHC network are quite small

May want to get off Advantage and go on on a Supplemental. Best decision I ever made. No issues with docs. Up to you.....

The timeline with Devoted since 12/31/2023 has deceptive procedures in the experience.
Receipts and claims were submitted by US mail on January 8th, 2024.
We learned from a devoted rep later on that the claim was in-fact received and denied but "member had no way to be notified"
That was total B.S. Claim went in US mail, denial notice should be in US mail. Devoted never did that until April.
Turns out fine print in EOC had 3/31/2024 as last date to file a claim.
So Devoted INTENTIONALLY kept member in the dark until 2nd quarter.
This is not an appeal issue IT IS A FRAUD issue and Devoted has to be held accountable.
Amount for both me and wife is $ 560
$ 560 that we would never have spent if the benefit wasn't out there.

I’ve have had Devoted for two years now.
Granted the providers are not super close. They have a 5 star rating for customer service. Have you called them?
I’ve used my Devoted dollars several times. The monthly food cards are good at Winn Dixie, Publix and Walmart. Not Aldi’s. The reward dollars work too. I used mine in Temu! Can you be more specific with your issue.

I think my previous post says alot of detail.
They claimed I could check my claim status at anytime.
But there was never any online account setup. And devoted KNOWS THAT.
I even had a dental claim to submit in January, by US mail, that got a check in the US mail 3 weeks later.
So Devoted is singling out the Wellness Bucks for denials.
And expecting seniors to navigate the 2-factor authentication crap everytime, to deal with matters that are not secure in nature.
It wasn't until April that someone at devoted established that online path.
DEVOTED INTENTIONAL DENIED AND REFUSED TO USE U.S.MAIL to response to member. Documented.
Know who's going to make them internally look and see this fault.

Is there not a customer Service line? I have Humana and never had an issue they didn't solve. I think the PPO plan I have is terrific.

Agreed but a big part of it is your personal physician and their support staff sending out referrals and clinical info to Humana in a fast manner

You can't deal with customer service when the issue is corporate policy and intentional actions.