TexasCHLforum.com

TomsTXCHL wrote:

G26ster wrote:Ask anyone trying to sell you an Advantage plan one hypothetical question. "If I develop cancer down the road, is MD Anderdson Cancer Center (or really and nationally recognized cancer hospital) in my network?" If the answer is no, you may want to consider Original Medicare w/Medigap supplement, and a Part D drug plan.

Well MD Anderson is one I suppose but WHO KNOWS: what kind of specialized care I might need down the road, and whether any plan I sign-up for today will cover X-Y-Z tomorrow.

I have not talked to any sales people just yet because I want to get educated first, so I am surfing like crazy on this. Unfortunately it does not seem like the critical info I might need is online, namely "is thus and such clinic or doctor in-network for this plan" and "does Dr. XYZ accept medicare".

Tell me specifically please what decision I must make correctly now that if I don't I am "out of luck for life"?

You must make the decision about going advantage plan or regular medicare. If you go regular medicare you need a supplement (medigap) and a plan D (Rx plan). With regular medicare you should be able to get into any facility in the country. With an Advantage plan you will be limited. An Advantage plan will cost less up front but when you need surgery expect to pay more ( probably much more) than regular medicare. So, if you can guarantee that you will NEVER need major medical care and will just die quietly in your sleep go Advantage plan. If you are like most of us and will run up big bills go regular medicare.

If the doctor doesn't take Medicare then he won't take the supplement. The supplement only is for the amount that medicare doesn't pay. But first the doctor must take medicare. Many doctors are not taking medicare anymore. Blame the government for that. My supplement is an "F" supplement. Costs about $170 a month or so. Then you also need a D plan for prescription coverage. It really is confusing for many people and since there are time limits on when you can get these it can really confuse the average person. A good insurance agent not pushing advantage plans can guide you through the process. All of the supplements offer the same services, they just cost different from different companies. An "F" plan from one insurance company is the same as an "F" plan from another, premiums may be different though. Some insurance companies low ball you the first year and then really raise rates the next, so shop and ask questions. My USAA plan usually pays the doctor faster than medicare does. One of the advantages of former military service. I also trust USAA with all of my insurance needs.

TomsTXCHL wrote:

G26ster wrote:Thanks Rotor. makes sense. Yes, although my Advantage HMO has been really great since 2008 even with some pretty heavy duty bills and procedures, when it comes to a catastrophic illness, and you want the best possible doctors available in the country, they fall short, as you are restricted in doctor and hospital choice to those in your network. My advice to anyone soon to retire (65 and over) is to avoid a Medicare Advantage Plan, and take advantage of the 6 month "guaranteed right" window after signing up for Medicare Part B, where you cannot be turned down for pre-existing conditions of any kind with a Medigap supplement plan. If you miss this 6 month window, you are basically out of luck for life, with a few rare exceptions, in getting a supplement should you become a victim of a catastrophic illness.

I guess your comment that I bolded above is directed at folks with a nasty preexisting condition? Sorry don't understand you.

I am about to turn 65, am already on SS thus I've been automatically signed-up for Parts A and B, and am being absolutely hounded by insurance agents representing the various Advantage plans. And in surfing the medicare web site itself, I find that I can sign-up for most/any of these plans directly thru the medicare.gov site without apparently dealing with ANY of these "exchange" companies (e.g. extendhealth/oneexchange from Tower Watson).

I don't know WHAT the heck to do, but I've got a couple months still to think and study on it. As healthy as I am (knocks on wood) I still have a GP and a Urologist and a Dermatologist and a Gastroenterologist and <who else> so am thinking still that I want an Advantage plan and co-pays of $15-50 bucks and some minimal prescription help.

My personal recommendation is to be on regular medicare, get a medicare supplement from a good company ( USAA was for me) and there are various priced and featured supplements so you have to study this, buy a plan D prescription (in my area the choice was Humana (didn't like) or AARP (was good and you don't need to join AARP). There are time limits that you must do this and I believe that if you do this right when you turn 65 you are OK but later on you can't or are penalized. The advantage plans in my opinion are not the way to go.

I agree. I have regular medicare and a supplement from USAA. I think that is the best way to go. Advantage plans are not really medicare. They are private insurance and they are a big money maker for insurance companies. The more they limit you the more money they make. Regular medicare will get you into any doctor in the country that takes medicare and more and more are refusing. People don't realize that medicare money is being shifted to obamacare. You worked your whole life and someone who never worked a day is getting the benefit.

cb1000rider wrote:I've never seen what you've experienced. The only time I've seen a doctor's visit be at a reasonable cash rate was for a flight exam where they only accept cash.
Every other procedure - especially dental procedures and emergency visits, the listed rate was far far above what the "negotiated" rate was with my insurance company.
And yes, you can absolutely negotiate down (up front) with smaller offices if you're paying cash, but often the rate for people who can pay for it, especially if they need it now - emergency/urgent care.. Rates are just crazy.

I can't speak for large clinics but in my area of Texas doctors fees are negotiable for cash paying patients. Barter works too. Same for lab fees. Always bargain for rate reductions with your doctor. Ask to see the price list. Ask for a reduction like to Blue Cross rates plus 10%. Most doctors will jump on that. Labs, shop around. Panels are usually cheaper than individual lab tests. The problem is that most non-medical people just don't know how to work the system. I am still working on the dental system though. I could buy my next car for the price of my implant work. I deal with some labs that charge $300 for a test and other labs that do it for $40. We need ombudsman for non-insurance patients. My wife picked up a script today for $24 at United. I checked WalMart and it's a $4 script. I asked her why she picked United vs WM or Sams Club. "I was going shopping for dinner". That's $20 more for dinner.

G26ster wrote:If there's someone here that is knowledgeable in State health law, I have one for you. I am in a Medicare Advantage HMO. This means I must deal with the PCPs and specialists in my network. I wanted to get a second opinion from a noted specialist at UT Southwestern in Dallas (UT Southwestern does not accept my insurance). I told them I would pay cash. I was informed that Texas state law prohibits them from accepting cash from a patient who has health insurance, even if they do not accept that insurance. Any one ever heard of this?

It is Federal law. A doctor that accepts medicare can not accept such a cash payment from a medicare beneficiary outside of the medicare system for a covered service. Now if the service is not covered by medicare, like some plastic cosmetic surgery, the doctor makes you sign an ABN (I believe that's what it is called) which tells you that the service is not covered by medicare. A second opinion though is a covered service and therefore the doctor if he agrees to see you must accept payment from medicare and since you are an advantage hmo patient and the doctor is outside your network you just won't get seen. You give up a lot when you become an advantage patient. Having insurance does not mean having a card. You must know the network of doctors and hospitals provided. In an hmo the doctor gets paid for not growing corn, as you probably now know.
Options for you, don't tell the consulting doctor you have medicare- I guess you would have to give a false name and ss#. Very hard to do as almost every clinic will require photo id. On the other hand, you can complain like mad, write a letter to the editor, your hmo may make an exemption. Best of luck.

Crossfire wrote:I just got a phone call from my doctors office. I have a little "procedure" scheduled in a few weeks, and they wanted to let me know that my part, based on my insurance coverage, would be $450.

OK, but I lost my job, and my coverage has terminated. So, I asked what the cost would be if I paid cash. She worked through the numbers and said, "cash payment - no insurance - $358."

WHAT??? So, tell me again - why do I need insurance???

Again, doctors fees are pretty much set by the government and contracts with insurance companies are set by what the government fee is. When you have no insurance and the doctor has no hastle or expense dealing with insurance ( which he can not legally charge you less than the insurance contract as by definition that is insurance fraud and punishable with jail time) he can bargain with you and charge what he wants. Knowing your circumstances he can give you a break or whatever. I personally like the cash price listed at the door and bargain with the doc will almost always work. Money received today is better than money received in 90 days (maybe).

cb1000rider, Almost all doctors submit their claims electronically. The only practices that don't are in areas that are in the hinetrlands with no internet access and they are given an exemption. Research ICD10 yourself to see why the government needs to know if you are attacked by a turtle. They are data-mining the population. Questions about your sexual preferences, etc are all required info now. The claim is that it is for your health. And they also claim that registration of firearms is to protect you. Believe what you want.
As far as computers, I am very much in favor of them. In a bank though it is not the bank president that inputs all the data it is the peons at the front end that do that. In a doctors office it is the most highly skilled person doing the input, which takes away time from seeing sick people unless he can afford to hire a scribe (my hospital ER did this as the docs couldn't see the patients and input everything-more cost to you of course). Electronic health records are very expensive to maintain and input, tremendously time consuming and frustrating for the user. For the company that sells the stuff it is the pot of gold at the end of the rainbow.
Finally, there are places to go outside the US that do provide good medical care at reasonable prices. I was impressed with Costa Rica but NOT MEXICO. Again, with all of the counterfeit meds, I no longer trust what they sell in Mexico or Canada to be real. We have seen anti-cancer meds that were phony introduced into the US. There are people without scruples that will do anything for money.

cb1000rider wrote:

VMI77 wrote:he medical profession is exempted from monopoly and restraint of trade laws. The whole system is a government facilitated rip-off. Unless that changes, yep, only the rich well be able to afford healthcare and those who are on the government tab will not be treated for certain conditions because it costs too much. Already happening in the UK.

Break it down for me. Locally, there are probably 50 or more "family practice" doctors. I'd say that's a reasonable level of competition.
However, they don't compete.... I can't really can't shop around due to insurance.

It seems like there's a real problem with the insurance implementation. If I walk into a family practice doctor, no insurance, but able to pay, I'm likely to spend $200-$250 for a few minutes of that doctors time.
With insurance, the payment to the doctor drops to about 60% of that - say $120 or so... Even though having insurance costs the doctor much more to process than having cash.
My out of pocket with insurance? Maybe $20 or so... Not counting the $750 or so that my employer and I are spending every month for that coverage.

It just seems very backwards to me. Dental care is the same way.

However, I can go down to Mexico and for some procedures where the standard of care and technology are on par, I may pay 75-85% less than the prevailing cash rate...

I don't claim to have a solution, I'm just claiming that the only thing worse than Obamacare would be allowing the status-quo for another 2 decades. And I might be wrong on that - both may implode.

Go to Mexico then for your care. No malpractice insurance, disposable instruments used multiple times, medicine that may be counterfeit from China, and we all know that the legal system and police will protect you from anything illegal. Have you been smoking that funny stuff?

The problem with the American medical system is the government. Pricing is done by the government with everything in relation to what Medicare pays. Almost every insurance policy pays a doctor on the basis of Medicare. Doctors fees are about 8% of the cost of getting sick. The hospitals are where you get ripped off big time. But worry not because with Obamacare you will probably not end up seeing a doctor. Your "health care provider" will now be a nurse or less. I still like the system that I use for my pets, I pay for care on the spot at a reasonable rate and the vet doesn't have to spend a million dollars just to computerize his records so that the government will know if my dog prefers critters of the same or opposite sex. On Oct 1, 2014 ICD10 will hit every doctor's office. The new required coding system ordered by Medicare. Cost to a solo practice will be between $80,000 to $220,000 and will not in anyway benefit the doctor or patient but will allow the government to spy on you with even greater ease. Look for many senior doctors to post their retirement notices in your local paper close to that date.

Dear Gringo
When I turned 65 I had only one choice if I wanted insurance, going on Medicare or going bare. To call that embracing Medicare would be far from the truth. I went from a very affordable Blue Cross plan to what for me was a more expensive Medicare plan when I factored in my monthly withdrawal from my SS, supplement and Medicare D. Prior to Medicare every doctor would see me, now the doors are no longer open. When you turn 65 there are no private plans available. Medicare stinks but at least it was put forward as the only choice for a vulnerable part of our society. What Obamacare does though is it forces everyone into a plan even though they had a choice before to get or not get insurance. the only members of society that did not have a choice were those age 65 or older. Even those with high risk situations could have joined a state pool to get insurance but not the senior. I would have been very happy to have the government require private insurance to insure seniors and I am not talking about advantage plans which stink. I would still have my Blue Cross policy now and not be on Medicare.

We are all only seeing the tip of the iceberg with Obamacare. My wife's Blue Cross plan went up about $40 a month and the letter specifically said because of the ACA and we were thrilled that it didn't get cancelled (at least not for next year). The real issue is what will your doctor do (see Obamacare people or not) or will you even get to see a doctor? I predict that most new insured will be in a medicaid style plan, will get assigned to a nurse practicioner or physician assistant ( or perhaps even less) and will not know what level of care they are receiving or not receiving. The rich and politicians will always get superior care. Pelosi can get into her private jet and go anywhere in the world. You had better pray that you have a good doctor, access to a good hospital and access to the best drugs. You don't necessarily want $4 WalMart chemotherapy when the real stuff costs $70,000 a month. Having an insurance card in your pocket doesn't mean a thing. Cash my friend is KING.