MAPD/pre-auth denied cancer treatment

[NewbieNewbie]

Sorry to hear about your cancer . In the Atlanta area I’ve not seen 1 dr or hospital not in the big mapd CO’s networks . I’ve moved so many from med sup to mapd . Never a complaint once . No doubt their will be some issues at times . All self employed people me included are in closed aca hmo plans . I have Ambetter and have been very happy . But I agree a wealthy person should be on a med sup . He has no reason to worry about the premium .

Thank you. And I agree it depends on the area. As you mentioned in your area pretty much everyone is in network and you are right advantage can be a winner all day long in that situation. For instance my parents. My dad live in a high saturated ma market and that is what he has. He has never had trouble seeing anyone.yom on the other hand does not. She has a plan G.

 

[BibH]

And the wealthy person could care a less about the 3900.00 Max OOP either. They are smart enough to keep the premium in their savings account and get free dental, vision, gym, great PDP etc. Part of the reason these people are wealthy is because they have common sense with their money. I will NEVER understand the reasoning of agents saying rich people need a Med Sup.

Because to save $3 k a yr a wealthy person doesn’t want even the Spector of hassle with pre authorization. We all know if your in skilled nursing mapd’s kicking you out after 8 days or so . As I said I’ve seen few issues but they are out there . A wealthy persons willing to pay up to not deal with its ANY issues .

 

[somarco]

I agree it depends on the area.

And your health . . .

 

[somarco]

That is not what a PPO means necessarily. At what cost? PPO does not mean you get to pick your own doctors and I really hope you are not telling people that.

If you can go to any provider then you don't have a managed care plan.

That is difficult for some folks to grasp.

 

[Midlevel]

Because to save $3 k a yr a wealthy person doesn’t want even the Spector of hassle with pre authorization. We all know if your in skilled nursing mapd’s kicking you out after 8 days or so . As I said I’ve seen few issues but they are out there . A wealthy persons willing to pay up to not deal with its ANY issues .

I guess I deal with different wealthy people.

 

[sman]

Here's a decent study with more than anecdotal information on both MAPD and Medicare alone (or with a Med Supp). One interesting fact, the MA program cost an average of $321 more per person than Medicare alone (based on the 2019 benefit year).

https://www.kff.org/report-section/...l-medicare-a-review-of-the-literature-report/