Fraud Police

[goillini52]

If youre being serious, I don't think you need to worry too much about PAs it happens seamlessly in most cases.

Only one lately who had an issue with a PA was on the Rx side. Darn it, she only got 46 of her norcos while they had a PA wait for a bit, I think 3 days, meanwhile she had enough of her norco to last. She was raising holy hell with me. This was last week. Yesterday her PA went through and she got the rest. of her 195 norcos per month. Not exactly sure the real number bc she changed it several times, but she claimed 195.

With Aetna, I've not had one complaint on a PA. Or any other carrier for that matter. Maybe it matters the area and how many docs take it. But I'm always hard pressed to find a doc that doesn't accept most mapds in my area. Found one that didn't take bcbs. but he doesn't accept medicare in general. Found a few hospitals that don't take UHC but thts fine too, it's not in my counties at all as far as MAPD. Two years ago there was a supposed week wait on a neurologist for Humana with a lady being tested for dementia. I believe that wasn't quite accurate as he also had a wait list to get into...i knew who the neuro was and he's a hard to get a fast appt doc anyway.

Let us know if you use your trial period (or another safety net) to move back. So far I've told everyone they have that option, and NOT ONE has wanted to go back, not even the cancer patients or otherwise (my cancer people so far have all had GTL). I get an occasional call about what was this $325 bill for an outpatient....or something like that....I nver have to remind them about what they saved during the year. They already know and tell me the minute I remind them of their trial period. Took this exact call today which is why the example was top on my mind. She says, oh no we love our humana plan. had a minor complaint of getting eyeglasses at Costco and being out of network, but got a claim form and not an issue. She said even if it doesnt work out shes still happy. Both her and hubby combined has 3 outpatient surgeries in past year. Only received the one $325 bill which kind of confused me but I kept it quiet. I knew on Humana it shouldve been 3 bills but they only received one on the most recent outpatient surgery.

Michigan is even nicer in some aspects with the BCBSM PPO MAPD, many things do not need a PA at all and there are quite a few things that have zero copays, like hip or knee outpatient surg, cardiac and pulmonary rehab etc. Yes these plans aren't the worst at all. Not near as demon like as some would proclaim.

Dont worry about the certs. Once you do em once, theyre easy. And here, the older ones with memory problems get in office "help". You could too if need be. Theyre still a pita, but generally painless, more a time suck than anything. I'm betting youll do it all yourself with ease.

My wife had to get a PA on one of her meds last year on Aetna's PDP. I assume the same will happen on the MAPD.

Saw this sign Monday at one of the clinics we use.

 

[Tahoe Ray]

My wife had to get a PA on one of her meds last year on Aetna's PDP. I assume the same will happen on the MAPD.

Saw this sign Monday at one of the clinics we use.

View attachment 10716

Do you think they had to tear the perforated edges off that flyer? What's up with that border? LOL.

 

[goillini52]

Do you think they had to tear the perforated edges off that flyer? What's up with that border? LOL.

 

[somarco]

You will both be lucky to make it through the year being on MAPD. Like a death wish.



So MAPD policyholders die sooner than those with OM + Medigap? Is that part of the CMS approved sales pitch?

Maybe they don't actually die sooner, but wish they would . . .

 

[Fisher]

It's scary how many frauds are committed every day in the healthcare industry.

Good bot.

 

[LostDollar]

Do you think they had to tear the perforated edges off that flyer? What's up with that border? LOL.

Bet it was special scissors.

Had to emphasize STOP.