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Keys to a Successful Doctor's Appointment
Visiting Mayo Clinic | Last Active: Oct 4 10:56am | Replies (57)Comment receiving replies
There is one more issue with the Advantage Plans I forgot to mention. When one first goes on Medicare, all plans (Advantage or Medigap) must accept you no matter your health issues. But after that when one is no longer satisfied with the Advantage Plan they have and would like to go back to Original Medicare and buy a Medigap Plan to cover the 20% Medicare does not pay, then there is a problem. The other insurance plans do not have to accept you or can charge you a higher premium....and if you are then having health issues...why would they want to accept you??? Sick people cut into their profits. Advantage Plans are profitable for insurance companies because they cut what they pay their doctors, require approvals and deny coverage, charge for visits, and push people towards the least expensive treatment. Look at their financial statements - percent profit, administrative costs, sales and marketing costs (think of what all the advertising on TV costs!) ....there are lots of articles in the press about this and there are lots of complaints.
Replies to "There is one more issue with the Advantage Plans I forgot to mention. When one first..."
You are correct. I have been in traditional Medicare with a supplement. I wanted to change from one supplement plan to another. (It was cheaper and offered the same benefits, as supplement plans are required to do). I needed “medical underwriting” to switch. Medical underwriting consisted of a non-medical person calling me on the phone, asking 12 questions. I was denied because I was taking one mg of prednisone, which was on his list of medications which led to denial. Couldn’t believe it. My agent said they don’t like unusual conditions??? The next year, I started sooner, pressed my case and changed supplements. I’m sure if I was in an Advantage plan, I would never have gotten into traditional Medicare. Advantage plans can change benefits, list of providers, etc. at any time. Traditional Medicare cannot.
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Between us, vic83, we are giving people much food for thought over insurance, a good thing. My advantage program is: "We are a not-for-profit, physician-directed health plan licensed under Article 44 of the Public Health Law of New York State." I have a PPO as opposed to a HMO and do not require approvals and am not denied coverage as long as who and where I go accepts Medicare. Anyone who can find such an excellent insurance company - and I agree that many cannot, unfortunately - should have it. My doctors are quick to send me for tests, referrals, etc., as needed. I even got to go to the Mayo Clinic in Rochester for heart surgery without a referral from them! I have not heard any complaints from other people, a high percentage in this area use this same insurance company, both the HMP and PPO plans. We are fortunate. Yes, you are right that there have been negative articles in the press and many complaints, I have read them, some of them should not be in business according to the way they treat their customers. As we are both discussing, each person needs to evaluate the options available to them and find the best one for their specific situation. I think that people concerned about insurance and Mayo should call both Mayo's billing department and their insurance provider to discuss their unique concerns. I did and they both were so pleasant and helpful.