Teacher Terry
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
- Joined
- Jun 17, 2014
- Messages
- 7,085
or die.
That’s what MA plans are counting on. 60 minutes did a segment on this.
or die.
@mathjak:
Obviously you have your opinion. But Medicare Advantage is 'govt Medicare'. A plan who wants to sell it has to be willing to provide ALL the services covered by traditional Medicare.
@dashman Govt Medicare pays at 80% of the approved charges. This means a fee schedule that the provider who accepts assignment agrees to. That does not mean that the Medicare Advantage plan only pays 80%, they pay based on fee schedule from the health plan, and a co-pay system that can result in far less than the 20% that govt Medicare doesn't cover.
@ Pluperfect Accepts assignment means that a provider agrees to accept the Meedicare rates - a fee schedule - plus meet certain requirements regarding being certified to accept Medicare. The physician cannot bill any charges in excess of the fee schedule.
In comparison, Medicare Supplement plans just pick up the difference between 80% and 100%.
If a PPO plans says you can refer yourself to any specialist who accepts Medicare, that means you pick a provider from their provider directory for a lower co-pay, or pick a provider who accepts Medicare for a higher co-pay. It is up to the specialist to contact the MA plan to determine coverage and any restrictions the plan may have about the details of the visit (procedure, drugs, etc.).
As to appeals, if the person who lost the appeal didn't clearly show that both the Welcome to Medicare book wording and Medicare Advantage wording for the same benefit match - and they didn't receive services, then, it has nothing to do with govt Medicare and everything to do with how they presented their case.
if only it was that simple ..and no a private insurance company administering your coverage is not the same as govt medicare who is not for profit administrating it
why do you think so many hospitals don’t want to accept advantage plans and are dropping them breaking their contracts or not renewing them , but they accept medicare