New healthcare thread...

[TIDE-HSV]

To be precise, when you refer to "C", that's Medicare Advantage. I assume you're referring to a LTC supplement?.

No. BCBS AL/TN refer to their traditional Medicare Medigap as "C+". It is not an Advantage plan. They do have one, called "Blue Advantage," which they push because it's so profitable. They make their money basically by denying coverage, since the final decision on treatment lies with the bureaucrats at the Advantage company, rather than with your doctor. Since people probably won't listen to the report you and I did, the victim developed melanoma on his ear and ran into delay after delay because his Advantage company kept delaying treatment until it was as large as a dime. When he tried to leave his Advantage company and re-sign with traditional Medicare Medicap, he found that that was the only part of Medicare which can consider pre-existing conditions into account, so his Medigap premium was prohibitive. IOW, Advantage is a one-way road, if your health goes bad. Then it becomes a trap you can't get out of. I believe most people think they can leave Advantage at any time and go back to traditional Medigap. Turns out that's not true...

 

[crimsonaudio]

I've got a few years but goodness, medicare seems really complicated from my perspective.

 

[NationalTitles18]

I've got a few years but goodness, medicare seems really complicated from my perspective.

Far more complicated than need be. All to make a few people richer.

 

[TexasBama]

No. BCBS AL/TN refer to their traditional Medicare Medigap as "C+". It is not an Advantage plan. They do have one, called "Blue Advantage," which they push because it's so profitable. They make their money basically by denying coverage, since the final decision on treatment lies with the bureaucrats at the Advantage company, rather than with your doctor. Since people probably won't listen to the report you and I did, the victim developed melanoma on his ear and ran into delay after delay because his Advantage company kept delaying treatment until it was as large as a dime. When he tried to leave his Advantage company and re-sign with traditional Medicare Medicap, he found that that was the only part of Medicare which can consider pre-existing conditions into account, so his Medigap premium was prohibitive. IOW, Advantage is a one-way road, if your health goes bad. Then it becomes a trap you can't get out of. I believe most people think they can leave Advantage at any time and go back to traditional Medigap. Turns out that's not true...

I did some googling and the C+ up there is unique to AL/TN BCBS. There's appears to be nothing comparable in Texas (of course). I have a UHC supplement (Medigap) here that's good but doesn't cover LTC. UHC has a supplement they call C+, but it's not any different than what I have now. New York Life does offer a LTC policy through AARP.

 

[crimsonaudio]

Far more complicated than need be. All to make a few people richer.

Assuming you accept medicare I cannot imagine how many hoops you have to jump through.

 

[TexasBama]

I've got a few years but goodness, medicare seems really complicated from my perspective.

I spent some time time researching the options for sure, but it's pretty simple after you go through the exercise, Earle's long term care issue aside. But you have the LTC issue now. It's something that would be wise for the both of us to look into.

The jist of Medicare is pretty much:

Option 1 - Medicare Advantage. It's cheap, and can be free. Your Medicare part A money gets paid to an insurance company. You have a policy with the usual conditions - deductibles, which doctors you can see, coverage limits, etc. And denial of payment. I had no desire to roll those dice.

Option 2 - traditional Medicare. Part A is no cost, Part B for me is about 170 a month, Part D (Rx drugs) is about 8 bucks a month. Then my Medigap is about 140 a month, which covers anything not paid by Part A or Part B. So, for a little over 300 a month, LTC aside, my only out of pocket besides premiums is the annual 233 dollar Part B deductible. And I can go to any doctor or hospital I wish. None of that gatekeeper doctor business, although I do like my GP. It would only take one ailment to blow the joy of the Advantage option out of the water.

An aside, but I was on Marketplace insurance for a few years, since I'm a sole proprietor and couldn't get a business policy. MD Anderson doesn't accept Marketplace insurance.

 

[twofbyc]

It’s a personal decision that each individual should look at everything and make their choices based on their own situation.
I did, and like all my insurance I reevaluate each time a policy expires. LTC is not a high priority because, frankly, barring a major accident or massive stroke (which I’m being proactive about), I don’t think I’ll live long enough to need it. And it’s simply not cost effective for us.
As for denial of service, a state-specific (non-national) MA plan would be more adversely affected by negative public reviews for such an action in an obvious situation, such that chancing a hit to subscribers might not be worth 50-100 thousand for a specific member’s treatment. Reputation is very important in a small market.

 

[TIDE-HSV]

It’s a personal decision that each individual should look at everything and make their choices based on their own situation.
I did, and like all my insurance I reevaluate each time a policy expires. LTC is not a high priority because, frankly, barring a major accident or massive stroke (which I’m being proactive about), I don’t think I’ll live long enough to need it. And it’s simply not cost effective for us.
As for denial of service, a state-specific (non-national) MA plan would be more adversely affected by negative public reviews for such an action in an obvious situation, such that chancing a hit to subscribers might not be worth 50-100 thousand for a specific member’s treatment. Reputation is very important in a small market.

IOW, it's a crapshoot you're willing to take. You are dead wrong on Advantage plans denying or slow-walking treatment. Talk to your doctor and they'll affirm that. Screw reputation. It's the bottom line and individual cases don't matter that much, when it comes to very expensive treatments. As I said above, I didn't consider either Advantage or Plan F until I reached my mid-80s. (BTW, I never expected to reach this age, and, when I was a kid, the betting was I wouldn't live to adulthood.) Bottom line, I consider Advantage plans to be a massive fraud, and, if you'll do the research, you'll find many health analysts agree with me. Nevertheless, I hope it works out for you. In any event, you're locked in. If you develop a serious condition and are denied or delayed coverage, you can't go back to traditional Medigap, without immense premiums...

 

[NationalTitles18]

Assuming you accept medicare I cannot imagine how many hoops you have to jump through.

Give me Medicare all day long over MA or even traditional insurance when something needs to be done - imaging, referral, you name it - it's so much easier with traditional Medicare.

 

[TIDE-HSV]

Give me Medicare all day long over MA or even traditional insurance when something needs to be done - imaging, referral, you name it - it's so much easier with traditional Medicare.

In addition, BCBS, if it's the state administrator, is the choice. I think I posted it above, but I tried both United (there was an expose' on NPR on United this morning) and Humana first. My nephrologist was having to write a letter to Humana to authorize treatment and he told me how much faster and easier BCBS was. I changed and have never been sorry. I had to see a surgeon recently because of an injury and I noticed that they had warnings up that they did not accept Humana or United. Yesterday, as I was checking out at the ENT, there was a warning up that they did not accept Cigna...

 

[TexasBama]

In addition, BCBS, if it's the state administrator, is the choice. I think I posted it above, but I tried both United (there was an expose' on NPR on United this morning) and Humana first. My nephrologist was having to write a letter to Humana to authorize treatment and he told me how much faster and easier BCBS was. I changed and have never been sorry. I had to see a surgeon recently because of an injury and I noticed that they had warnings up that they did not accept Humana or United. Yesterday, as I was checking out at the ENT, there was a warning up that they did not accept Cigna...

I remember BCBS as the administrator in dealing with my mother's insurance years ago. Novitas is the current administrator here.

 

[TIDE-HSV]

I remember BCBS as the administrator in dealing with my mother's insurance years ago. Novitas is the current administrator here.

Are they also a provider, like BC?

 

[TexasBama]

Are they also a provider, like BC?

No, just a CMS administration contractor

 

[Bazza]

Tomorrow I go in for Carpal Tunnel surgery on my left wrist.

It will be the first surgery for me ever - and I turn 70 this June, so not bad.

Co-pay is $175.

I have Humana.....and so far it's been great.

My GP said no more $5/year co-pays.

Had to have an MRI done on my left wrist leading up to this surgery and X-rays. Co-pays on those were $150 for the MRI and I think it was $25 on the X-rays.

I can live with that......

 

[crimsonaudio]

Best of luck to you, @Bazza !

 

[CrimsonJazz]

Hope your procedure goes well for you @Bazza !!

 

[Bazza]

Best of luck to you, @Bazza !

Thank you, CA.

I'm in good hands, pun intended!

They just moved my surgery up a couple hours, which is good because I'm not allowed any food after midnight. I told them I'll bring a banana to have as soon as I'm allowed to eat again.

I told them a banana seems to be the perfect food item to consume afterwards....and if they like they could include that recommendation in their future pre-surgery directives.

I mean.....it's one thing to tell you what you CAN'T do........sometimes it helps to tell folks what they CAN do.

 

[TIDE-HSV]

Tomorrow I go in for Carpal Tunnel surgery on my left wrist.

It will be the first surgery for me ever - and I turn 70 this June, so not bad.

Co-pay is $175.

I have Humana.....and so far it's been great.

My GP said no more $5/year co-pays.

Had to have an MRI done on my left wrist leading up to this surgery and X-rays. Co-pays on those were $150 for the MRI and I think it was $25 on the X-rays.

I can live with that......

With BCBS C+, I don't have a copay, even for major surgeries. Of course, there's the annual premium. Good luck with the hand. I had it on my left hand years ago. They said that I would need it on my right also, but, somehow it quit going dead at night and I've never had to have it. A veterinarian client of mine commented on its being unusual to have to have it first on the non-dominant hand. I tried to explain to her that I use my left hand extensively. The problem is that things I do left-handed are awkward with my right and vice versa. I switch at baseball and softball - more power right and higher average left...

 

[Bazza]

With BCBS C+, I don't have a copay, even for major surgeries. Of course, there's the annual premium. Good luck with the hand. I had it on my left hand years ago. They said that I would need it on my right also, but, somehow it quit going dead at night and I've never had to have it. A veterinarian client of mine commented on its being unusual to have to have it first on the non-dominant hand. I tried to explain to her that I use my left hand extensively. The problem is that things I do left-handed are awkward with my right and vice versa. I switch at baseball and softball - more power right and higher average left...

I was also told my right wrist, my dominant, may need it too so good to know that's not an absolute!

Someone else said after they had the procedure they wished they had done it sooner.

I haven't been in pain so much....it's just that the tingling-numbing stuff is so annoying!

Thank you.

 

[TIDE-HSV]

I was also told my right wrist, my dominant, may need it too so good to know that's not an absolute!

Someone else said after they had the procedure they wished they had done it sooner.

I haven't been in pain so much....it's just that the tingling-numbing stuff is so annoying!

Thank you.

When you have to dangle your arm off the side of the bed in the middle of the night, you know you need it. In my case, my right tested as much worse than my left. When I complained to the surgeon that almost all my symptoms were on the left, he said "Don't worry; we treat symptoms, not tests"...