Unsolicited comment regarding first hand experience with a Medicare PPO plan is enlightening . . .
Pinned by Georgia Medicare Plans Bob Vineyard
18 minutes ago
I don't live in Georgia, but to me the scariest thing about the Advantage plans are the pre-authorization requirements and the frequency of denials for claims. In addition, there are other traps related to these issues. Some MA PPO plans even make claims about out of network providers that are not what they seem. My company has a MA PPO plan for retirees which states that the cost sharing for out of network and in network is the same, and that out of network providers are never required to do pre-authorization. Sounds great! Just go to a out of network provider and the provider doesn't have to seek pre-authorization! What they don't tell you in the marketing materials (but is buried in the Evidence of Coverage document, which all MA insurers are required to produce) is that pre-authorization is still in place; it's just that the out of network provider doesn't have to do the paperwork. In network providers are required to do the pre-authorization steps, which is part of the contract. For out of network providers, the patients themselves are responsible, and if they don't initiate and complete pre-authorization (which will be a beauracratic nightmare), the "plan" can deny providing anything, leaving the patient to foot the entire bill. So people need to read the Evidence of Coverage documents for any Medicare Advantage plans very carefully. In the end, the "Plan" is in charge of your healthcare, not your doctors. And the "Plan" exists to make money.
Pinned by Georgia Medicare Plans Bob Vineyard
