BSW and Humana Medicare Advantage

3,110 Views | 12 Replies | Last: 1 mo ago by EBrazosAg
75AG
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AG
Just got notice that my former employer has switched to a Humana Group Medicare PPO plan from UHC. Humana brochure states for out-of-network providers, Humana "will provide coverage for this member".

Since BSW stopped accepting Humana, are they considered out-of-network, or something more sinister? Will BSW still bill Humana? Or am I SOL and will need to find a new doctor? Thanks for any advice!
MsDoubleD81
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AG
I'm having the same issue with my employers retiree Aetna Medicare PPO. I've been with BSW for over 20 years. I got email from BSW that they have failed to reach negotiations with Aetna. I'm looking into supplement.
happyinBCS
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I have Plan G supplement with Mutual of Omaha and they are great, been with them for 5 years now
75AG
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Spoke to BSW this morning. They will not bill Humana, so everything would be paid by me, and then reimbursed by Humana to me. How fun!

New doctor time.
trouble
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That's what I'm gonna have to do so my kids can keep seeing KidDoc
MsDoubleD81
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AG
I just spoke with both Aetna and BSW. Because I have a Medicare PPO ESA, they pay same amount for either in-network or out-of-network. They both said i have a really good plan. Thank God!
75AG
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AG
I have the same. But will BSW file for you, bill you, or require full payment at the time of service?
MsDoubleD81
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I have an Aetna Medicare PPO ESA. Its different than regular Medicare Advantage. They said they'd file thru Aetna.
MsDoubleD81
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It pays the same whether in network or out.
Doug Funny
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BSW is marketing their Medicare Advantage program. It is financially advantageous to them to be the MA provider, not to engage with another insuring party.

Medicare Advantage can be very restrictive for specialist care and medications. Perhaps cost effective for those who want to see a doc every time they have sniffles or gas, not so great if there is a condition that is not "by the book" or computer screen, these days.

Medicare Advantage providers are financially incentivized to load up the patients' diagnoses. The "sicker" their patient load the higher Medicare reimbursement. That can easily lead to over prescribing, too. For those who are not defensive consumers of medical care it can create a sense of diminished well being that may not be warranted.

All of these comments are based upon research and first hand experience.
histag10
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trouble said:

That's what I'm gonna have to do so my kids can keep seeing KidDoc


Because im knocked up, kids will self pay at kiddoc until baby gives us a special enrollment period and we can look at other private insurance. None will insure us right now with me being pregnant. (Currently on a marketplace plan that is skyrocketing next year)
75AG
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I decided to switch Medicare Advantage provider to stay with BSW. Easier than finding all new docs.
EBrazosAg
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While I completely understand the financial incentives for MA, I tell my patients to get MA if they think they are going to be healthy up until the day before they die. It's a great deal in that situation. Otherwise it can be very limiting and many find that out when it's later not sooner. As a strategy for Medicare, it's a disaster that lines the pockets of insurance companies and causes difficulty for patients and physicians. Again - i understand the financial incentives and if you are in a position where that weighs strongly it's what one should sign up for.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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