MA PFFS horror stories

[senior-advisor-indiana]

I would like to hear some stories of bad experiences with MA plans. Stories you have heard from clients personally or from an agent you trust.

I have a story and here it is.

I met with a couple 2 days ago and they were telling me that when they were in Arizona, the wife went to the hospital. I'm not sure what she went for but she had the procedure done. IT was out patient I believe. WEll anyway they paid thier co-pay. They then recieved a bill later on. It said that the doc accepted the plan but the anestesiologist did not. They had to pay the $1300 anestesiologist bill outta there pocket and that does not count towards the Max out of pocket for the year.

 

[insurance0707]

ouch...that doesn't sound right. That anesthesiologist would have had to tell them up front I would think. I believe they have some rule that states if they treat the patient they'll be considered deemed for that visit. That doesn't mean they have to continue to treat the patients. They may want to look into that.

 

[insurance0707]

At the very least they should call the MA and find out the rules on it.

 

[senior-advisor-indiana]

I am sure they probably made them sign something that said that he would not accept the plan, but did nnot know what they were signing.

 

[David C]

Sometimes it is just a business model decision. The anesthesiologist, radiologist, and a couple of other medical types that you have to have are not on ANY PPO. You have to use their service if you have surgery, therefore you have to pay their rates regardless of your insurance.

 

[senior-advisor-indiana]

i do not like the uncertainty about MA plans. There is no telling how muc you can spend in a year.

 

[sman]

I would like to hear some stories of bad experiences with MA plans. Stories you have heard from clients personally or from an agent you trust.

I have a story and here it is.

I met with a couple 2 days ago and they were telling me that when they were in Arizona, the wife went to the hospital. I'm not sure what she went for but she had the procedure done. IT was out patient I believe. WEll anyway they paid thier co-pay. They then recieved a bill later on. It said that the doc accepted the plan but the anestesiologist did not. They had to pay the $1300 anestesiologist bill outta there pocket and that does not count towards the Max out of pocket for the year.

At the very least, they can file a claim with the MA carrier and get reimbursed what they would have paid to an anesthesiologist.

 

[Frank Stastny]

The same kind of "horror stories" that we all have heard and know regarding HMO's are going to be the same kind of stories we will be hearing about PFFS/Advantage plans.

I still think they have a place but that "place" is not for everyone or for people who want a reliable supplement to their Medicare. As in the example, people who travel a lot may really be put in a bind.

Every person who takes a PFFS/Advantage plan needs to be educated about what questions they need to ask when going to any health care provider.

 

[Slick]

I agree with Frank, I tell everyone to ask the big question, "what's this going to cost me?". My own father in law got hit with a $2,500 heart monitor!?! I don't know the details but he did say he didn't know he agreed to buy it.

What about when a person signs in to the hospital, it seems at that time they can amend the contract with a simple phrase such as:

All charges not covered by my primary insurance provider must be seperately approved.

It's a contract and if they accept you as a patient then they accept the amendment.

 

[midwestbroker]

In the first situation, I would file an appeal with the MA carrier. If that did not help, file a grievance with them.

What MA plans have done or are going to have to do, is educate their clients about taking their health care into their own hands. Asking questions about surgeries, procedures, tests, etc. Basically become more involved then they might have been in the past.

With a supplement, some providers have left their patients in the dark, since they can bill Meidcare for it and the patient never knows any different.

Some people may not want to do this, so a supplement is the best thing for them. Others, including some of my clients, have become more involved in their health care. Funny thing is, they are normally the healthest ones.