Healthcare/Insurance cost rant

I read that one of the thoughts for Medicare is to make Advantage plans the default Medicare. A lot of people will go for that. A friend of mine has an Advantage plan with no premiums but she has a high deductible. She said it works for her because she doesn't have any health conditions. I think that's a huge gamble because no one knows when they can be hit with a chronic disease. I was in my 50s when I got UC.

Buckle up ... I suspect lots of changes are on the way ... for just about everything. That's all I will say except stock up on wine ;)

So I applied for my Plan G medgap plan and the Part D drug plan today. I refuse to use United Healthcare for anything (yes I know those are good plans, but they started this employer insurance mess* and I don't want to do business with them) so I got a BCBS plan and then a Cigna plan for my drugs. Premiums seem reasonable -- $127/mo for BCBS and $12.60/mo for Cigna. I have them both set to start 1/1/25 so I should be set now.

*Employer insurance still doesn't have a new contract. It's already having an affect on wait times with docs with the other provider. A co-worker's father needed a new PCP so he had his 1st appt with her doc who is with that other provider. When he went to make his 6 month appt he had to be pushed out to 7 months and the co-worker asked if it was because they were getting so many new patients from my provider and she was told that was the case. It's only been a week!! Not 100% sure this is true (co-worker has been known to catastrophize (sp?) things sometimes), but I just heard the name of another large employer that is caught up in this mess so it's possible. Hopefully they get this settled soon before it creates more problems for people.

My doc's nurse wasn't sure about the PA for Medicare so she sent it to their 3rd party company who does PAs. Infusion is 1/2. Hope they do a quick answer since we have holidays coming up.

My employer insurance finally settled with my healthcare group. Unfortunately they didn't make it retroactive so my Nov & Dec infusions were out of network. I have the continuity of care form that is supposed to mean that they will be treated as if in network as usual, but they have reprocessed the 11/7 claim 3 times and denied them as out of network. I don't know what is going on. My benefits admin is working on it. Hopefully.

I have enormous empathy for people who face medical bankruptcy now. I am pretty sure my situation will eventually get straightened out, but the possibility that it won't has me worried and depressed.

I wish politicians would stop pointing fingers and being stubborn and just act like adults to get a better healthcare system in this country. We have plenty of examples around the world that we could pick the best parts of many options and come up with a great system. But sadly, that's just wishful thinking.

I had to switch my infusion clinic. When the new clinic billed Medicare and BCBS they used the nurses name... Not a problem.... Everything went thru fine.

I went in last week and my nurse quit.... And so I had to verify that the doctor over the clinic, the clinic and the person administering the infusion were all preferred providers. The nurses name started with a V and yet the infusion clinic said they were billing it under Cherry and that it would all be covered. (No Cherry was at the clinic....) So I went ahead and had the infusion.... But gosh am I scared. I have to use preferred providers....BCBS doesn't cover "in network" providers that accept BCBS but did not sign a contract with them.... apparently preferred providers are limited in what they will be reimbursed because they signed a contract. They make it so complicated.

Today I received nasty EOBs indicating some of my ostomy supplies will not be covered by BCBS because the company had a "non preferred" warehouse mail them to me...instead of sending the supplies to the home office and then they could mail them to me.

I'm so frustrated. I think that if Medicare pays their portion you shouldn't have to use only preferred providers or get pre-approval for things with your secondary insurance company. Now I'm looking at 110.00 a month since the beginning of the year because BCBS is trying to say that all my supplies were shipped from the Texas warehouse that's not preferred....and when I tried to talk to them they asked to see the shipping boxes to prove where they were shipped from. Good grief ...

And to think we have to start trying to get our pre approval done before our 2025 infusions.....😭

I need some wine .......

Clo

All the hassles they hit us with are 99% unnecessary, and probably 2025 will bring on still more of them. The insurers want us to back down and pay up-- out-of-pocket. BTW, I read that many news readers have expressed surprise over recent comments criticizing UHC policies, rather than expressing horror over the shooting of that health insurance company's CEO. The surprised readers must be healthy! / Old Hat





old

I have wondered why insurance board members, ceos, upper management employees...etc...are drawing such large salaries and yet everyone's benefits are scrutinized and denied if possible. I hired a young lady that worked at an insurance company (a very very long time ago) and she said a portion of her bonuses were based on how many claims she could deny. I was never able to verify that so I am unsure if that was true ..but it always made me wonder.

I'm all for capitalism but when it comes to healthcare ... This is just wrong. Their large salaries are depleting funds that the insurance companies could be used to expand or pay current claims that are impacting others...with denials causing the possibility of causing death for some individuals. And then there are the lobbyist that are working for them.....

I'm grateful for Medicare and the limiting amount left over. Today I had a doctor that I've seen many times... Suddenly my last visit was not covered because he moved into the suite next door..... So it voided his contract. He was applying to BCBS for preferred status in that suite but my visit fell in the few days he was in the new location and before they authorized the new suite....

What hogwash.

Gosh I wish I could drink a large glass of wine.

Flowers Gal, when I first started with Medicare, I had my own private policy with BCBS. I kept it because I was on Humira at the time, this was many years ago. I was paying $610 a month just for myself for 2 years. The 3rd year they increased the monthly premium to $1,220 a month which I dropped. I was no longer on Humira. BCBS did not cover the 20%, they paid pennies on the dollar plus the regular deductible.

I have saved a lot of money when I switched to a supplemental plan, I went with F & have been grandfathered in. I have not had any issues & the same with my husband. Private insurance just doesn't jive well with Medicare.

The premiums go up every year. I’m now up to almost $250/month. And then there’s the original Medicare premium which I’m not even sure how much it is as it’s automatically deducted from social security. I believe it’s less than $200. Very much worth it.

Vent warning ... Vent warning...

Doctor that moved suites is adjusting his bill....only because his office manager left a voicemail in May that they would not charge me if there was an issue. They argued until I played the voicemail back to them ...and even then the first thing they said was..."Who saves a VM that long?". Lol...

The ostomy supplies is still being denied.....(But their rep said they'd adjust it off if need be ..yet they refused to send me a letter or email stating that....)

AND.... That last infusion was denied by BCBS! Aaaaaaaagghhhhhh!

My infusion was delayed over 2 hours while their insurance supervisor ran everything thru BCBS...she even got a verbal pre-approval....and yet it was denied. The infusion clinic called Tuesday morning to tell me I have to pay that deductable up front going forward plus this last amount... Until they have something in writing from Insurance... I cancelled my next infusion until I get this straightened out.

I'm scared to try only Medicare because if I drop my retirement insurance I can't get it back----ever---and I could not get my retirement office to call me to confirm possible solutions. (Like putting it on hold or suspension?) So...I'm stuck for 2025. I'll get thru this year and watch what happens with you all and be better prepared in 2026.

Clo

Wow, Clo! That's crazy that they went with just a verbal PA on your last infusion. Don't they have fax/email?? I hope you get this all straightened out soon. It's got to be so stressful! Is you doc's office working with BCBS to get the PA for the infusions? They should be able to get a rush PA so you can get the infusion on time.

Check out your state's medicare help website and search for Medicare advisors in your area to help you figure out what would be best for you. They get really busy during open enrollment so try to start early. The advisor I used is also an insurance agent for many companies so he compared annual costs with multiple companies.

In your situation, you definitely need help to decide what is best for you. If you go on regular Medicare you will need to get a document from your employer/retirement office showing that you were continuously covered by medicare equivalent policy.

My employer insurance still hasn't straightened out the 11/7 infusion claim, and the 12/5 claim still says "under review". sigh

Plan F HD,if I could do over probably plan N. Have to pay own hosp bills,as you get older and sicker becomes a pain. Hosp billing is a mess. For instance my last EOB from Cigna is 28 pages for the pacemaker. Of course only pay 65/month,but can' switch now.
old mike

CC, finally some good news for you. You should not have any issues with Medicare & your supplemental insurance going forward.

Clo took out an individual private insurance plan instead of a regular Medicare supplemental plan. She is stuck with having to use in network drs & hospitals to help with the 20% Medicare doesn't pay. Maybe next year she will switch over, it would save a lot of grief & a little money.