If the lab is contracted with that MA, they cannot balance bill you. If they are OON they may be allowed to. But it also sounds like Maine has some good protections so maybe you are ok. And sometimes a provider’s billing office will send a bill before the claim is processed by the insurance company.
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OK, we’ll see!
Again, all of the above showing what a byzantine, expensive, wasteful “system” we have, with commercial insurance companies drinking from the trough. Ugh, ugh, ugh, while I wait for a call from a specialist or his staff regarding medication. The call will either cost me zero or $50 if it’s billed as a telemedicine visit.
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I’m convinced anesthesiology groups were out of network on purpose.
Because they are mostly private groups, meaning not owned by the hospitals, and didn’t like the low reimbursement rates from insurance. More money for the partners.
I think that loophole is being has been closed. Because you have no control on the anesthesiologist you receive.
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I think the anesthesiologists didn’t like their low contracts so most went out of network and figure patients and med centers have no choice if everyone is OON and patient is high risk. I have gotten our insurer to pay our OON pediatric anesthesia costs when S needed someone and I had no say in who was used. The facility and everyone else was participating a preferred and it took sometime but insurer finally paid the OON amount.
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The anesthesiologist for my last colonoscopy tried to bill as out of network although both the facility and the GI were in network. It took a couple of phone calls to remind them about the state, and now federal, “surprise billing” laws. And then the excuse was “Our software hasn’t been updated”. I don’t believe that AT ALL. I believe they aren’t following the law in the hope that people will see the bill and just pay it. So annoying.
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I remember my first surgery my doctor (who had to leave his office at 8 am and thus cancel or squish his patients for the morning, and then visit me that evening and again the next day) got paid about $700 and the anesthesiologist got his full $2k or $3k and he was at the hospital (as he was supposed to be) and just took the hour or so for the surgery. I always thought that was so unfair.
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Did you mean to write managed care? If so, and mangled is an autocorrect replacement, it is hilarious and so true.
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I absolutely intended to call it MANGLED care! Many of us in healthcare (and others) have referred to managed care as mangled care for a long time because that is what it is! Glad you caught it! Maybe I’ll add that to that post (that that is NOT a typo) .
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I wasn’t sure but thought it funny either way. H is in healthcare and is useless in figuring out billing things but his office manager is a billing savant. I go straight to her will any issues. H does have strong opinions on which insurance companies he’d never use voluntarily. It’s helpful as we transition to Medicare and have choices. MA is a big no.
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I guess it’s only the people who post on here who have MA plans who love them?
I’m sure there are some that are great and you are lucky to have one. But in his experience they are hard to manage from a caregiver perspective. He’s not fond of many non-MA insurance plans too. No disrespect intended.
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I think my supplemental plan is around $280 a month. Hubby has an Advantage plan. He just spent an hour on the phone trying to find out where his authorizations were, why, when he can make an appointment, etc. So glad I got the supplemental plan instead. No worries about out of network.
Over the past 18 months, my medical treatments have been well over $100,000. I have paid zero apart from premiums. And I can go to the top facilities, the doctors and hospitals of my choice. The best.
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It’s just so weird that plans are so different. DH has never had to do anything to go where he wants.
Depends on the plan. My MA plan has no in/out of network. Everyone who takes Medicare takes this plan.
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DH’s plan must not have in/out of network, either, because it’s never come up.
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Has he had to use it in a state other then Maine?
Our plan is used by people who even live out of our state.
As stated numerous times…all Medicare Advantage Plans are not the same. Some are much more robust than others.
Yes, YOUR specialty state/teacher employee retirement plan does, but MANY MA plans do not (other than for urgent/emergency care.) Many docs in other states may not accept a plan they are not contracted with. My question was asked to @MaineLonghorn.
This is also an important consideration for people purchasing most MA plans (not some specialty state retiree plans which, like the wonderful government retiree insurance, most people cannot get). If a retiree plans to travel more than 6 months outside their service area, they may be kicked off their MA plans. There are special plans that cover snowbirds and others who plan to travel domestically.
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