Pretty much not true.
Medicare Advantage Plans
- Thread starter Donald
- Start date
All assertions or just some?
United Healthcare treats their insured like a burden on their pocketbook.
"You WILL be discriminated against if you have it and actually want to use it."
Two years for us now. You are right in one case, we do give a **** about our health and in decent shape, but they have paid for my skin issues, looking up my poop chute, the wife's "shot" cause heart valve thickening issues, my new toof, our gym, etc........
WE ARE using it. What you write isn't true.
What is true in your case may not be so for other cases.
Doesn't sound like you're on United Healthcare. Nor is discrimination merely outright denials.
They denied coverage for a chemo drug that was supposed to be covered by it. So the Medstar hospital was the "victim" and they just "ate" the cost.
UHC is very much a publicly traded company; thus Wall Street does influence their behavior.
You are not writing clearly or honestly
You write in general then you write about a singular bad actor
If your gripe is legal and legitimate- which I assume it is - Do ALL your state and US congress people know? How about your insurance commissioner? State AG Office?
I have Humana which is a publicly traded company. I don’t think UHC was a choice in my county.
Source please, this way I can tear it apart. *LOL*
I cant do it unless you provide the story.
This is why there is more to it.
Private Medical Insurance has to cover EVERYTHING traditional medicare covers. It's that simple, so if something was denied, there is more to the story.
Sounds like the Hospital made a huge mistake which BTW kills over 200,000 Americans a year by medical mistakes.
Advanage C and Medigap (example part N, G and D medical) plans are form private insurance companies if you are not aware.
I like UHC A LOT, 4.5 MILLION Americans use UHC for their medicare plans. I suspect UHC makes way less mistakes than 4.5 million Americans dealing with hospital bills. Hospitals are the victims of their own mistakes.
Last edited:
The insured are the burden of any insurance company.
Good news is no one is forced to buy it, purely optional.
Stop that! my wife and I are paying for your pickleball paddles to the tune of $174/mo out of my social security!
Medicare pays private insurers ~ $15, 000/yr Capitation rate to take you off their rolls.
Vatic Pro Prism Flash, LOL!
For Human-sized scaled up ping-pong game! Is a vigorous game of Tennis too tough for you old codgers?
Don't mention this to my wife - she is out on that noisy Wiffle Tennis court up the street as I type
Last edited:
Stop!!!! *LOL*Stop that! my wife and I are paying for your pickleball paddles to the tune of $174/mo out of my social security!
Vatic Pro Prism Flash, LOL!
For Human-sized scaled up ping-pong game! Is a vigorous game of Tennis too tough for you old codgers?
Don't mention this to my wife - she is out on that noisy Wiffle Tennis court up the street as I type
They already bought me the Vatic Pro Prism Flash in Jan!
Now, arriving on Saturday is the more expensive Vatic Pro Flash ( I believe it a 3rd gen) *LOL*
Prism is gen 2/2.5
Non Prism is gen 3
Actually cant wait to try it out, many video reviews on both. For sure, the Vatic Pro Prism Flash is the paddle to beat in its price range.
I like the you tuber, "pickleball studio" straight up guy and says this is the paddle to beat anywhere near its price range and has no business selling at the low price it does.
I absolute LOVE it. With money to burn, I want to try a bit more of a power paddle for fun and so the Pro Flash (no prism) being I like my Prism Flash so much, I dont want too much of a difference and honestly like the value the company provides even though I dont pay for them. But it says something about the company, having high rated paddles that compete against some of the more and most costly.
I was tempted to have my Advantage C plan pay for a Double Black Diamond but think I am kidding myself as I have barely been playing a year. But the Vatic Pro Prism that arrives on Saturday is the same Gen 3 paddle as the Double Black Diamond and compares favorably.
Ps, you may have missed another post, they also bought me my Apple Watch 9 for $379 but the plan limits you to one watch per year *LOL* and they bought my $300 contacts and they paid $1,750 of my dentist bill for an implant. Next year they will pay another $1,750 for the implant abutment and so far gave me $90 over over the counter medical stuff, vitamins etc...
(ok, im getting carried away. I have yard work to do, time to work up a sweat)
Last edited:
@CKN
I go to thank you though I already discussed I am happy with my Advantage C out of country coverage which is $250,000 and no deductible. Something because of your post made me question my wife's company that she works for policy and it's a big company.
I can not find ANYTHING in her policy (and I am pretty good at reading these things, such as multi hundred page Evidence of Coverage for C plans.
Anyway, she has an email into her Human Resources but in the meantime I can not find any statements regarding out of Country Emergency in her company policy. I am wondering if any company policies have that coverage?
I go to thank you though I already discussed I am happy with my Advantage C out of country coverage which is $250,000 and no deductible. Something because of your post made me question my wife's company that she works for policy and it's a big company.
I can not find ANYTHING in her policy (and I am pretty good at reading these things, such as multi hundred page Evidence of Coverage for C plans.
Anyway, she has an email into her Human Resources but in the meantime I can not find any statements regarding out of Country Emergency in her company policy. I am wondering if any company policies have that coverage?
Update- well I found something. Still waiting to hear from her company but I found this in Forbes.
First note, I see nothing in her company policy about out of country coverage, well, it doesnt exist after seeing this story in Forbes.
SO here I have my Advantage C plan that will pay up to $250,000 but my wife's company insurance doesnt pay anything.
I am happy for @CKN post or I would not have looked into it for her as I knew I was covered.
So she will have to buy out of country coverage from another company. Because her workplace does not provide it. Anyway thanks CKN.
If anyone has recommendations it would help. I see in those plans unlike my Advantage C where I have no stipulations, some of these out of country policies have stipulations, such as getting hurt doing dangerous activities like parasailing etc.
This is in regard to regular Insurance like company insurance. NOT MEDICARE PLANS, even if your company policy does cover out of country if you read the story you can still get whacked with out of network costs. Not so with my Advantage C plan and others.
Important to read your policy like I just learned regarding my wife's company policy.
I always read inside and out my Advantage Policies.
SOurce - https://www.forbes.com/advisor/health-insurance/does-health-insurance-cover-you-outside-us/
My UHC and Aetna Advantage C plans had/have out of country coverage for those not following the last few posts.
This is my current Aetna Advantage C plan
This was my last UHC, Advantage C plan, seems to appear as no limit out of country
First note, I see nothing in her company policy about out of country coverage, well, it doesnt exist after seeing this story in Forbes.
SO here I have my Advantage C plan that will pay up to $250,000 but my wife's company insurance doesnt pay anything.
I am happy for @CKN post or I would not have looked into it for her as I knew I was covered.
So she will have to buy out of country coverage from another company. Because her workplace does not provide it. Anyway thanks CKN.
If anyone has recommendations it would help. I see in those plans unlike my Advantage C where I have no stipulations, some of these out of country policies have stipulations, such as getting hurt doing dangerous activities like parasailing etc.
This is in regard to regular Insurance like company insurance. NOT MEDICARE PLANS, even if your company policy does cover out of country if you read the story you can still get whacked with out of network costs. Not so with my Advantage C plan and others.
Important to read your policy like I just learned regarding my wife's company policy.
I always read inside and out my Advantage Policies.
SOurce - https://www.forbes.com/advisor/health-insurance/does-health-insurance-cover-you-outside-us/
My UHC and Aetna Advantage C plans had/have out of country coverage for those not following the last few posts.
This is my current Aetna Advantage C plan
This was my last UHC, Advantage C plan, seems to appear as no limit out of country
Last edited:
I am thinking Aetna's $1,200 fitness expense reimbursement benefit will be reduced in the upcoming plan year based on CVS (Aetna) last earnings report.
Keep seeing this come up but have not read most of it. Will get back to it. Went with Aetna Gold Advantage HMO, for the most part I've been happy. Seems to cover the St Louis area completely, including both teaching hospitals. I'm aware that I might get some rare cancer that is beyond Barnes and a trip to M.D. Anderson will be my only salvation. I'm pushing eighty so if it's the end, it's the end. Don't think I'd ever travel thousands of miles anyway. I would think an HMO in an area without the hospital choice of a market like St. Louis might be problematic. I had a friend who had a medigap policy whose wife had something so rare that Barnes only saw a handful of cases a year. He was able to go to Rochester and in this case he guessed right by not getting into an advantage plan.
I've had a wife and a girlfriend both die while on advantage plans and never felt they were being nickel and dimed. They pulled out a pretty expensive defib/pace maker out of my wife and put in a more expensive one a few weeks before she died. (We're swapping a Lexus for a Mercedes.) If there was whining on the part of the insurer I didn't hear it.
My daughter works in billing for one of Barnes community hospitals and reports hassles by insurers if things aren't correctly submitted, but we all know that happens.
When CVS bought Aetna we got a lot of push for going to their in-pharmacy NP's. I went to one for a burn on my back and asked all the right questions as to charges, etc. I got an $80 bill from CVS Labs of Kansas for back end lab work-- all billing came out of Woonsocket, RI. Also went to one of the many Luxotica optometrists for glasses. Specifically told them that I was going to my ophthalmologist in two weeks and to skip any pressure testing or diabetic exam, refractions only. Found the bill with insurance was $360 for glasses and refraction, $370 without. I paid the extra ten bucks but they back billed Aetna for an additional $1100. That's almost fifteen hundred for a cheap pair of glasses and no exam. When I contacted Aetna with notice of suspected fraud the billing notice came off of my patient portal. CVS and Luxotica are two of the more disreputable health players IMHO. Did I catch someone with their hand in the cookie jar? If I was younger I'd keep pushing for an answer.
On balance I'm happy with all the extra goodies I get with the Advantage Plan, they seem to pay off, and cover a large medical market completely. Silver Sneakers is great. I'm willing to bet that anything I have will be covered without leaving the area. Were I to live in a micropolitan area of 20,000 with a thirty bed community hospital, I think I'd be in a medigap.
I've had a wife and a girlfriend both die while on advantage plans and never felt they were being nickel and dimed. They pulled out a pretty expensive defib/pace maker out of my wife and put in a more expensive one a few weeks before she died. (We're swapping a Lexus for a Mercedes.) If there was whining on the part of the insurer I didn't hear it.
My daughter works in billing for one of Barnes community hospitals and reports hassles by insurers if things aren't correctly submitted, but we all know that happens.
When CVS bought Aetna we got a lot of push for going to their in-pharmacy NP's. I went to one for a burn on my back and asked all the right questions as to charges, etc. I got an $80 bill from CVS Labs of Kansas for back end lab work-- all billing came out of Woonsocket, RI. Also went to one of the many Luxotica optometrists for glasses. Specifically told them that I was going to my ophthalmologist in two weeks and to skip any pressure testing or diabetic exam, refractions only. Found the bill with insurance was $360 for glasses and refraction, $370 without. I paid the extra ten bucks but they back billed Aetna for an additional $1100. That's almost fifteen hundred for a cheap pair of glasses and no exam. When I contacted Aetna with notice of suspected fraud the billing notice came off of my patient portal. CVS and Luxotica are two of the more disreputable health players IMHO. Did I catch someone with their hand in the cookie jar? If I was younger I'd keep pushing for an answer.
On balance I'm happy with all the extra goodies I get with the Advantage Plan, they seem to pay off, and cover a large medical market completely. Silver Sneakers is great. I'm willing to bet that anything I have will be covered without leaving the area. Were I to live in a micropolitan area of 20,000 with a thirty bed community hospital, I think I'd be in a medigap.
Perks can and do change every year. That’s what I love about these plans. I can go shopping and pick the best one for the new year.
But as far as your statement, that’s just a personal thought. That would go for any company. All these plans are optional and companies offer incentives to attract you to their business. That’s what’s so great about competition.
My United healthcare plan, which is possible I could go to next year paid approximately $1500 for my Orangetheory. Gym membership, which would’ve cost me $120 a month.
Gotta love the free market!
Free to choose, free not to choose, nobody has to sign up if they don’t want to.
I love having no deductible health insurance!
Last edited:
Great post! I just wanted to address this one statement.
Choice is great and nothing wrong with Medigap but you talk highly of your advantage plan and if you were concerned instead of being in advantage HMO, you can go to advantage PPO and get care at any hospital network in the nation in which that particular insurance company does business such as with Aetna or United healthcare.
In that situation, I would simply select UnitedHealthcare PPO advantage plan in your area that enables you to go to any hospital in the country that United healthcare has an agreement with. Since United healthcare by far is the largest I would think your concerns would be alleviated..
With all that said we all pay for what we like and if somebody feels better with Medigap and associated cost that’s good too!
My brother went from Medigap G because of constantly raising rates to Humana advantage C because he knew how happy I was at the time with my united healthcare advantage C
The only reason commenting on this you brought up the device that was implanted in your wife. By the way, I am very sorry to hear about her. Boy, do I know all about heart disease the male side of my family is a train wreck. I am really crazy about trying to take care of myself and avoid it. so far I’m the longest living male without any major intervention, except for one ablation.
That time I had united healthcare advantage C. It was in 2022 and my bills were close to $130,000, my cost for the year was less than 1000.
if you’ve been following my posts, my brother who is in heart failure with an EF of 20 to 25 and counted approximately 1/2 million dollars retail cost of his healthcare two years ago.
Humana picked up every cost except for $2900 which was his out-of-pocket limit.
He also had a dual type pacemaker replaced with a tri type pacemaker.
It regulates his heartbeat and also the beat between the two chambers and has a built-in defibrillator in case something goes very wrong.
He also had an ablation done which was almost considered experimental at an institution two hours away from his house where the specialist used a state of the art imaging machine at the time that was something like one of two in the world which allowed the imaging for the procedure he needed.
We have found both in North Carolina and South Carolina that no matter what your plan is no major medical institution or any institution have we run across that didn’t take any of our advantage plans which also includes Duke university in North Carolina.
At one point, we were considering moving to Florida and I looked into plans there, and even the mayo clinic was in network
I do suspect maybe some expensive metropolitan areas, like New York might be different. I don’t know.
Sorry to hear about your wife, and great post well said on your advantage plan
Last edited:
You can walk in to any hospital and get emergency care (Network or not-in Network may not be close by) with any Advantage plan. The caveat comes if you are hospitalized-for an extended time. Your plan may want to move you to another hospital with "more advantageous charges" (for them).
Here is the rub-on a cruise ship. Will your (out of country) coverage pay $1,200.00 for a drug treatment that would normally cost say $300.00 on land. That's not an exaggeration. If they pay what's "usual and customary" then that's where travel insurance kicks in.
Correct, once you were stable if you are in a hospital that is not in their plan they can move you.
For me that would work out perfect because every hospital worth its weight in gold in north and South Carolina are in my plan and we’re in my past plan with UnitedHealth
But with that said we were a big country and due diligence is up to those who purchase any insurance.
Maybe some high cost areas this could be a problem, but that is only speculation. I don’t know. Might be, but it certainly easy to find out before you commit. Again due diligence rules.
I just posted to somebody else even Duke University and the Mayo Clinic was in my plans as well as every heart hospital and respected hospitals with advanced heart treatments.
Unless of course you want go to Medigap at a cost of many hundreds of dollars more a month then you don’t have to think about it. Thing is where you live you might not have to think about it anyway.
I was thinking they would reduce the expense reimbursement because the CVS earnings call transcript pointed out adverse trends in utilization and supplemental benefits (which would include the expense reimbursement category). Cutting the benefit is easy to do compared to trying to control utilization.
