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I was just scanning a few posts in this thread, and saw this. Please recognize that, like anything else in insurance, there may be exceptions to that statement.
Will All Seniors Eventually Have No Choice but Medicare Advantage?
- Thread starter Duaine
- Start date
Fewer physicians accepting Medicare due to low reimbursements
Some Medicare patients in Wichita find it increasingly difficult to find a new primary care physician.
For people on Medicare, one of the biggest trade-offs between Medicare Advantage and traditional Medicare is that Medicare Advantage plans have a more limited network of doctors and other providers.
www.kff.org
Further complicated when the senior has multiple providers and some of them may not be in network with all/any plans
Medicare Advantage: How Robust Are Plans’ Physician Networks? - Report - 9090 | KFF
Introduction For people on Medicare, one of the biggest trade-offs between Medicare Advantage and traditional Medicare is that Medicare Advantage plans have a more limited network of doctors and other providers. Medicare Advantage plans restrict the doctors, hospitals, and other providers from...
www.kff.org
Further complicated when the senior has multiple providers and some of them may not be in network with all/any plans
straightnochaser
Guru
- 549
^ that article is 7 years old..
- 1,162
My understanding has been that MA plans will (or must) cover OON specialists if there is not one INN to who can address the members problem. But it is in no way guaranteed. “I’ve got cancer and want a consult at MD Anderson” probably isn’t going to cut it unless it is a special case.If you are enrolled in a managed care plan (HMO, PPO or POS), your treatment at MD Anderson may be covered by insurance. Before scheduling an initial appointment, please call your health plan/insurance company and ask if you have access to health care services at MD Anderson. We encourage you to refer to Questions to Ask Your Insurance Company when speaking to your insurance provider.
If MD Anderson is not a participating provider, you may still be able to receive treatment here. Contact your insurance company and ask about obtaining authorization. It is important to note that some benefit plans utilize what are referred to as "narrow" or "limited" networks; that is, they further narrow or limit the choices of doctors and hospitals that their customers can use. Often, these networks exclude MD Anderson. Additionally, some plans, such as HMO’s, have primary care physician referral and/or other authorization guidelines.
Your MD Anderson patient access specialist will help you obtain the full benefit from your insurance plan by:
DISCLAIMER: MD Anderson's participation with any product or insurance plan is subject to change without notice. Additionally, insurance companies offer a variety of plans and may change the names and benefits at any point. A patient’s level of coverage depends on the specific benefits outlined in their plan.
- Answering your questions about insurance verification and/or prepayment requirement
- Responding to insurer requests for additional medical information.
To ensure that MD Anderson and its physicians are in-network, it is the patient's responsibility to verify that MD Anderson is a participating provider and their benefit plan allows them access as of the day of a visit and/or admission. Please contact your insurance plan to obtain this information.
Insurance Plans
If you are enrolled in a managed care plan (HMO, PPO or POS), your treatment at MD Anderson may be covered by insurance. See the list of accepted insurance plans here.www.mdanderson.org
Seems like a patient MAY be admitted for care at MD Anderson (or Mayo, or SK, or any other specialty hospital) but MAY have to jump through hoops to get there.
That is expecting a lot for someone who is 65+ and fighting cancer PLUS have to get PERMISSION from their PPO/HMO plan so they can get treatment.
Those with OM don't have to ask permission . . . they just go.
ONLY IF the provider agrees to accept the coverage. Non-par providers cannot be compelled to treat patients in non-emergency situations.
MD Anderson is just one example of an acute care facility that does not participate in ALL MA plans . . . there are plenty of other facilities that have similar rules for non-emergency care.
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