Quote:
Originally Posted by rsmurano
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.
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And to quote Luke Skywalker from Star Wars ep.8, "Everything in that post is wrong"
Medicare doesn't deny any service????
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?
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