Interesting article about the use of AI in denial of Medicare Advantage service/claims.
1 Like
I saw this. Is Medicare also using these algorithms? I noted reference to CMS guidelines, which is the federal government.
In MA we have a couple of weeks left for this yearās enrollment period and we can change to Medicare or change Medicare Advantage plans. I have been super happy with my BC/BS plan for $79/month but have an open mind for the future.
Would non-Medicare private insurance plans (e.g. employer or individual plans) also be using similar methods?
So far this year, providers have billed my husband $952 and he is responsible for $49.10. His Medicare Advantage premium is $0, so all he pays is $165 monthly for his Medicare premium.
Providers have billed me $2,045.10 this year. I am responsible for $1,412.87. My Anthem premium is $770/month. I canāt wait to turn 65!
The comparison has been similar for three years, and my husband has had several issues and visits to Urgent Care.
1 Like
Admittedly havenāt read the whole thread, but as a former provider, Medicare Advantage plans were terrible, denied coverage and were only interested in keeping their customers in the dark about the services they were denying or not paying for.
3 Likes
@jym626 that was in your state. In my state, this isnāt the caseā¦and againā¦repeating what Iāve said over and over.
All Medicare Advantage Plans are not the same. They simply arenāt.
Like @MaineLonghorn, we have had zero difficulty getting our bills paid. Our plan is a PPO that must be accepted by any provider who accepts Medicare. And it has been.
We have a dedicated number for members of our large group to call our MA plan folks for any problems we encounter. So far, (knock on wood) we have had none.
ETAā¦Iām not trying to convince anyone they should get a Medicare advantage plan. That is your decision to make.
3 Likes
The special plan in your state and my state that are the state employee retiree benefit plans are good plans, @thumper1, but VERY different from the plans they sell to unsuspecting individuals.
1 Like
My plan is not the one for state employeesā¦although they do have MA and through the same provider. My plan is through our teachers retirement boardā¦and itās not free for those of you wondering. We pay both the Medicare premium, and a monthly MA cost.
I understand that there are some MA advantage plans that arenāt terrific. But there are also private health insurance plans that arenāt terrific.
I think on this oneā¦the folks in this thread need to agree to disagree.
States and unions are in a very good position to negotiate good retiree healthcare plans with the insurance companies for their members. And as an example for some making decisions who might need it, all Mayo clinics accept traditional Medicare, but will accept very limited, if any, Medicare Advantage plan insurance.
4 Likes
Your plan is not something that the average person can get so yes, there are exceptions, but not for the average person. The best Advantage plans I know are only open to retired state, city, county, federal employees and union members. Many of my friends are retired teachers and they have incredible Advantage plans.
4 Likes
Totally agreeā¦and Iāve never said my plan was something anyone could get. What I have said isā¦my MA plan is a very good one.
As with anything elseā¦folks need to check their options out carefully. I have several friends who used Medicare brokers to get information, and they felt these folks were very even handed in how they presented the options to consider.
1 Like
Once again, my BC/BS PPO Blue Medicare Advantage Plan has been fantastic. I do think it varies state to state and company to company. I pay $79/month and have a $3k maximum out of pocket per year. I am not a former teacher or state employee. I met with 4 hospital financial counselors and they all suggested the same plan, with full knowledge of my several serious health challenges, including cancer.
My husbandās plan is for individuals. Heās never worked for the government or been in a union. And I can say that everyone I know in Maine who has this plan is satisfied.
Itās interesting that the people on this thread who actually have MA plans are happy with them.
2 Likes
Thank you @compmom for sharing your information. This is useful infomation for us to know. What is your state?
Anyone post this yet? https://www.nytimes.com/2023/03/10/business/medicare-advantage-retirement-nyc.html?smid=nytcore-ios-share&referringSource=articleShare
Paywallā¦can you gift the article to us?
@compmom just clarifyingā¦this $79 a month is in addition to your regular Medicare part B premium, right?
I can gift it if jym626 doesnāt repond soon.
@cbreeze Massachusetts. My plan also has a special program that provides home visits and check-ins, including blood tests and mobile x-rays and free behavioral health to deal with medical issues- all for free for those with 5+ qualifying conditions.
1 Like
@thumper1 yes, sorry I assumed that.
1 Like