Anyone here on Medicare and if so are you on a Humana advantage plan - or similar?

TIDE-HSV

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I had right colon resection on Jan. 26, 2018. The bill from Huntsville Hospital came in a few days ago. Medicare allowed $9K+ for the procedure. However, if I hadn't had Medicare or private insurance, the bill would have been $137K+...
 

UAH

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I had right colon resection on Jan. 26, 2018. The bill from Huntsville Hospital came in a few days ago. Medicare allowed $9K+ for the procedure. However, if I hadn't had Medicare or private insurance, the bill would have been $137K+...
That is an excellent point. Large insurers (corporate and government) get much of the cost of treating the uninsured, Medicaid and Medicare shifted to them due in part to their lack of power to negotiate pricing. When people talk about the trillions of added cost associated with a single payer system my response is... The US spends double per-capita on health care versus other developed countries. With that type of expenditure there has to be good faith solutions to actually lowering cost rather than adding the trillions people rant about. Doing that without reducing needed medical research and the rationing of treatment.
 

TIDE-HSV

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It's always crazy. Crestwood hospital billed almost $30K for the first, unsuccessful, basal cell cancer operation on my forehead back in October. It was done conventionally, with plastic surgery, general and all. Actual procedure time was probably 1.5 hours, but longer because of prep, anesthesia, etc. They were paid $7K+. The second, successful, Mohs surgery in December was done in an office, with local anesthesia. The actual surgery time was about the same. The procedure was so long because the incision and cancerous cells stretched from beside my right eye to the center of my forehead. If it had been the typical "spot" type of basal cell, then it would have gone faster. The first surgeon charged nearly $3K but got paid $789. The second charged around $1500 and got paid $786. Of course, the second surgeon did eight procedures, starting at 7:00 AM. IDK how the coding works and how the Mohs surgeon's fee is figured. Obviously, he should be paid a great deal more for an incision like mine.

Any way you cut it, he's making a lot more money. The first guy, a regular plastic surgeon, had time for only two procedures in a day. As I said earlier, in the other thread, the Mohs procedure, left me with minimal swelling, because he cauterized as he went, so I recommend it right and left for anyone who even suspects they may have a skin cancer. Also, Tolkachjov, the Mohs surgeon, came to the field with a background and training in trauma surgery, so he already knew reconstructive surgery and he then went into dermatology. Most Mohs surgeons are dermatologists who've taken additional training in surgery. I don't think I need to explain the difference. Even the first, plastic, surgeon, who did the followup, had to grudgingly concede that the reconstruction done was pretty good...
 

Moro Creek

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I had the Medicare Humana HMO plan when I first retired. After the first year, I switched over to the Medicare Florida Blue HMO plan. Florida Blue costs me a little less and they are much more responsive than Humana. On any of these plans, If you stay in network (which I do) you come out much better. I've had surgery for a hernia with probably the best surgeon in Ocala and my part of the cost was about $300.00. Hope this helps.
 

TIDE-HSV

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I had the Medicare Humana HMO plan when I first retired. After the first year, I switched over to the Medicare Florida Blue HMO plan. Florida Blue costs me a little less and they are much more responsive than Humana. On any of these plans, If you stay in network (which I do) you come out much better. I've had surgery for a hernia with probably the best surgeon in Ocala and my part of the cost was about $300.00. Hope this helps.
I started on Medicare with United and then switched to Humana, which I dropped after a couple of years, for the reasons you mentioned. When I went back into the plastic surgeon's office who'd done my first skin cancer surgery, I noticed at the checkout desk that they would accept neither AARP (United) nor Humana...
 

NationalTitles18

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I started on Medicare with United and then switched to Humana, which I dropped after a couple of years, for the reasons you mentioned. When I went back into the plastic surgeon's office who'd done my first skin cancer surgery, I noticed at the checkout desk that they would accept neither AARP (United) nor Humana...
I recommend avoiding both United and Humana, based on others' experiences. If you have to take insulin, get something other than Humana for sure.
 

TIDE-HSV

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I recommend avoiding both United and Humana, based on others' experiences. If you have to take insulin, get something other than Humana for sure.
One of my docs wanted to change my hypertension meds and Humana had him write a letter of justification. He said it was routine with Humana and that BCBS was the smoothest process (not that they can't also cause problems). I asked a couple of my other docs - I'm at an age where my body is divided up among specialists - and found that it was universal. They're sort of like a cut-rate auto insurance company - deny every claim you can to hold costs down and maximize profits. Thankfully, after the coronary bypass, I no longer have to take blood pressure meds...
 

NationalTitles18

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One of my docs wanted to change my hypertension meds and Humana had him write a letter of justification. He said it was routine with Humana and that BCBS was the smoothest process (not that they can't also cause problems). I asked a couple of my other docs - I'm at an age where my body is divided up among specialists - and found that it was universal. They're sort of like a cut-rate auto insurance company - deny every claim you can to hold costs down and maximize profits. Thankfully, after the coronary bypass, I no longer have to take blood pressure meds...
Happy for that last part.

Agree with your doc. BC/BS can be a pain, too, but nothing like Humana.

And of course since the start of the year every formulary has changed and all are denying meds they covered for however long, not to mention deductibles.
 

TIDE-HSV

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Happy for that last part.

Agree with your doc. BC/BS can be a pain, too, but nothing like Humana.

And of course since the start of the year every formulary has changed and all are denying meds they covered for however long, not to mention deductibles.
I know they sent me a letter that they were taking a drug off as "dangerous," which I've taken for over 50 years, really "must" take...
 

day-day

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...

Any way you cut it, he's making a lot more money. The first guy, a regular plastic surgeon, had time for only two procedures in a day. As I said earlier, in the other thread, the Mohs procedure, left me with minimal swelling, because he cauterized as he went, so I recommend it right and left for anyone who even suspects they may have a skin cancer. Also, Tolkachjov, the Mohs surgeon, came to the field with a background and training in trauma surgery, so he already knew reconstructive surgery and he then went into dermatology. Most Mohs surgeons are dermatologists who've taken additional training in surgery. I don't think I need to explain the difference. Even the first, plastic, surgeon, who did the followup, had to grudgingly concede that the reconstruction done was pretty good...
Good one!
 

Bazza

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Thanks for the thread contributions so far, guys.

Really nice to have the input.

Glad things are going better now for you, Earle. Best wishes going forward, sir!

Interesting comments about Humana - I will have to research more. Those I spoke to in this area all had nothing but good to say about them.
 

seebell

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Thanks for the thread contributions so far, guys.

Really nice to have the input.

Glad things are going better now for you, Earle. Best wishes going forward, sir!

Interesting comments about Humana - I will have to research more. Those I spoke to in this area all had nothing but good to say about them.
Check with your doctors and ask if they take Humana. Up here in North Alabama, Blue Cross is the way to go. Most of my doctors won't fool with United or Humana.

I have Medicare Part A and a Blue (Cross) Advantage plan that covers Part B and drugs. Been real happy with it. Last year the Advantage policy cost me $49 a month. This year the cost went down to zero and basic vision and dental became an added benefit. Blue Cross is my primary insurance. I don't even show my Medicare Card.

Medicare is on the verge of bankruptcy so the cost was reduced to zero and benefits were added!:eek2:
 

Bazza

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Check with your doctors and ask if they take Humana. Up here in North Alabama, Blue Cross is the way to go. Most of my doctors won't fool with United or Humana.

I have Medicare Part A and a Blue (Cross) Advantage plan that covers Part B and drugs. Been real happy with it. Last year the Advantage policy cost me $49 a month. This year the cost went down to zero and basic vision and dental became an added benefit. Blue Cross is my primary insurance. I don't even show my Medicare Card.

Medicare is on the verge of bankruptcy so the cost was reduced to zero and benefits were added!:eek2:
Thanks - good advice! That last part was supposed to be blue font, I'm assuming.....:wink:
 

seebell

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Thanks - good advice! That last part was supposed to be blue font, I'm assuming.....:wink:
No blue font Gator Man!:tongue: Bankruptcy might be too strong a term. My point is this: If revenues will only cover 91% of the costs in 8 years, why reduce my premium and increase my benefits now? Save for the approaching rainy day.

https://www.cbpp.org/research/health/medicare-is-not-bankrupt

Even in 2026, when the HI trust fund is projected to be depleted, incoming payroll taxes and other revenue will still be sufficient to pay 91 percent of Medicare hospital insurance costs.[1] The share of costs covered by dedicated revenues will decline slowly to 78 percent in 2042 and then rise gradually to 85 percent in 2092.

https://www.pgpf.org/analysis/2018/07/trustees-funding-challenges-threaten-medicares-future

I'm probably the only person on this forum that understands high finance! :biggrin:
 

Bazza

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No blue font Gator Man!:tongue: Bankruptcy might be too strong a term. My point is this: If revenues will only cover 91% of the costs in 8 years, why reduce my premium and increase my benefits now? Save for the approaching rainy day.

https://www.cbpp.org/research/health/medicare-is-not-bankrupt

Even in 2026, when the HI trust fund is projected to be depleted, incoming payroll taxes and other revenue will still be sufficient to pay 91 percent of Medicare hospital insurance costs.[1] The share of costs covered by dedicated revenues will decline slowly to 78 percent in 2042 and then rise gradually to 85 percent in 2092.

https://www.pgpf.org/analysis/2018/07/trustees-funding-challenges-threaten-medicares-future

I'm probably the only person on this forum that understands high finance! :biggrin:
I think it was your term "verge' that blew the comment up for me.

I will remain optimistic - as always - that things will work out. :)
 

Bazza

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For the past month, now that I'm closing in on my 65th birthday, I've been getting bombarded with junk mail regarding Medicare! Just now a young lady stopped by in person to ask if I wanted to sit down with her while she helped walk me through the whole process.

Even though she was pretty hawt, I still declined.

I'm already enrolled in Part A and B and have my card in hand effective June 1. I think since I was already enrolled (as of last year) in SS - this was an automatic process for the SS administration.

How are all these people being paid who are soliciting me? By the insurance companies, right? What a racket! :rolleyes:
 

TIDE-HSV

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For the past month, now that I'm closing in on my 65th birthday, I've been getting bombarded with junk mail regarding Medicare! Just now a young lady stopped by in person to ask if I wanted to sit down with her while she helped walk me through the whole process.

Even though she was pretty hawt, I still declined.

I'm already enrolled in Part A and B and have my card in hand effective June 1. I think since I was already enrolled (as of last year) in SS - this was an automatic process for the SS administration.

How are all these people being paid who are soliciting me? By the insurance companies, right? What a racket! :rolleyes:
You should be being bombarded by "insurance" calls by now, the vast majority of which are out and out scams...
 

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