It would not be unheard of for the customer service person you speak with at the insurance company to be wrong. I would telephone again....both your doctor's office and the insurance company.

As I understand it, Susan is correct....location seems to determine how drug treatment claim is paid and what your share might be AND whether your payment counts in meeting your annual out of pocket limit.

Also, other insurance company personnel who deal with the medical provider's billing department also may not have it right. This is why whenever a provider wants me to pay for co-insurance/copay prior to service for anything other than a doctor's office visit, I decline and state that I will pay what is owed after the claim is processed and the EOB is issued.

The 'donut hole' terminology does apply to both Medicare and Advantage plans. Susan has it right as I understand it. The difference is between Medicare Part B (most medical services provided outside of hospital as described in your Advantage Plan and no donut hole) and Part D.

I have AARP/United Medicare Advantage and they occasionally test my patience on claims processing. Seems to me like there are some games being played.....wonder whether it coincides with quarterly revenue reporting to shareholders.......shocking isn't it?