Category: Medicare

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Medicare    ????????????

The time of year for us senior citizens to make decisions on what kind of Medicare do we need.

I would say it would be determined by your income.

I would say it would be determined upon your health.

I would say it would be determined upon your doctor.

Now that you have determined this what is next.

But how do you determine if your doctor is on your Medicare plan.

Call Medicare. The customer service representative can tell you if your doctor is on your plan.

Medicare Plans

Regular Medicare

You pay 80% of your bill and you pay the 20%.

You can have a secondary insurance to cover the 20%.

HMO

This is the cheapest way to go but also the most aggravating.

You must pick a (PCP) a Primary Care Physician.

You must go by referral to a specialist or medical test.

You must have an authorization to have surgery or some specific test.

You must stay inside the contracted arena of medical care for your HMO.

PPO

You have more control over your medical care. But it does cost more.

Medicare/Medical or Medicaid

You need to qualify for this insurance.

It is for low income.

Whatever insurance you decide to go with always check with Medicare to make sure you are up-to-date in their computer system. 1-800-633-4227

www.lindameckler-author-author.com

My books Medicare and Other Health Insurances and Appeal and Collections Letters are available on Amazon.com.

Thank you for reading my article. Linda Meckler 2023 copyrighted

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Medicare Attack

This is now the time of year when Medicare starts mailing out information on every HMO and PPO that Medicare covers. Everyday handfuls of information will be in your mailbox. Does it make Medicare more confusing?

If you do not understand Medicare Parts A, B, C, D, and G you will not understand Medicare.

Part A is free if you qualify and it is inpatient in the hospital.

Everybody pays for part B which is all out-patient services doctor, ambulance, lab, x-ray, etc.

Medicare Part A and B is fine but it only pays for 80% of your medical bill. You are responsible for 20%.1556.00

This is good for 60 days

After 60 days the charge is $1556.00

The truth is the best Medicare coverage you can have is Medicare Part G a supplement. This, of course, is the most expensive. But if money is no object you can sign up for Medicare Part A and B and G when you sign up for the first time.

You pay monthly for the supplemental plan plus part D drug coverage.

If you have been on other Medicare plans and want to change to a supplemental plan you will have to answer health questions and might not be approved.

Advantage Plan -C- You can change your insurance plan once a year. Each plan is different. You pick your  primary care physician, you get a referral to go to a specialist and authorizations for surgery, etc.

If you do not have extra money to spend on your Medicare plan and HMO plan is the cheapest way to go. The only thing is if you are hospitalized then it becomes expensive.

PPO is another option it costs more than an HMO but it does have some advantages.

No matter what you decide it is complicated. Medicare makes it that way to confuse the public. My book Medicare and Other Health Plans explains Medicare and it is something everybody needs to know.

Thank you for reading my article. Linda Meckler    www.lindameckler-author-artist.com

Posted on by

Medicare Attack

This is now the time of year when Medicare starts mailing out information on every HMO and PPO that Medicare covers. Everyday handfuls of information will be in your mailbox. Does it make Medicare more confusing?

Part A is free if you qualify and it is inpatient in the hospital.

Everybody pays for part B which is all out patient services doctor, ambulance, lab, x-ray, etc.

Medicare Part A and B is fine but it only pays for 80% of your medical bill. You are responsible for 20%. When in the hospital you pay $1556.00 for 60 days. After 60 days you pay that amount again. 

The truth is the best Medicare coverage you can have is Medicare Part G a supplement. This, of course, is the most expensive. But if money is no object you can sign up for Medicare Part A and B and G when you sign up for the first time.

You pay monthly for the supplemental plan plus part D drug coverage.

If you have been on other Medicare plans and want to change to a supplemental plan you will have to answer health questions and might not be approved.

Advantage Plan -C- You can change your insurance plan once a year. Each plan is different. You pick your primary care physician, you get a referral to go to a specialist and authorizations for surgery, etc.

If you do not have extra money to spend on your Medicare plan and HMO plan is the cheapest way to go. The only thing is if you are hospitalized then it becomes expensive.

PPO is another option it costs more than an HMO but it does have some advantages.

No matter what you decide it is complicated. Medicare makes it that way to confuse the public. My book Medicare and Other Health Plans explains Medicare and it is something everybody needs to know.

Thank you for reading my article. Linda Meckler  www.lindameckler-author-artist.com

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Dental Insurance Screwups

In this article, I will give you an example of what can go wrong when you make a dental appointment and when you have HMO medical insurance.

I was in a dental office recently and watched this drama play out in front of my eyes. That is when I knew I had to write this article and add it to my Medicare and Other Health Insurances book.

This man had an appointment in this dental office. He was in pain. He checked in his list of Dentist’s that were contracted with his medical insurance. He called the Dentist and made an appointment.

What is wrong with this. Can you tell me?

Everything in medical or dental insurance works by contract. Yes, his medical insurance was contracted with this Dentist. But the man never called his insurance company and said, “I want his Dentist and I need an appointment immediately I am in pain.”

So, what happened? He didn’t make a contract with his medical insurance to plug him into this Dentist. He showed up and said, “I have an appointment and I’m in pain.”

The receptionist said, “I am sorry sir the Dentist can’t see you because you are not contracted with this office.”

“But you are on the list of dentists I was given that is on my plan”

“Sir, you did not call your insurance company and tell them you chose this Dentist and since you did it today the insurance company should have called us and we would have seen you.”

Whose fault was this mix-up?

It was both the Dental receptionist’s fault and the man’s. The receptionist should have called the insurance company when she didn’t see his name on the computer as being this Dentist’s patient.

The man should have realized how his insurance works.

In most cases, this is how we learn by doing.

Thank you for reading my article. Copyright Linda Meckler 2022

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Medicare HMO Horrors

www.lindameckler-author-artist.com

I have worked in medical insurance billing for almost thirty years. I have said repeatedly that the insurance companies practice medicine.

In an article in the AARP June Bulletin 2022, there is an article that does indeed prove what I have said.

This article states that when Medical Providers see their patients and require pre-authorization for testing, or surgery Medicare denies it.

Federal Investigators reviewed a week of these inquiries in 2019 and found that those denied 13% should have been authorized under the original Medicare rules. 85,000 requests that year were wrongfully denied.

What about the years before and after 2019?

Do not take for granted when something is denied that is denied permanently.

A medical appeal can always be sent to Medicare. If a medical provider requests pre-authorization for a test, surgery, etc. that means the patient needs it. If the patient does not receive the care needed, you can use your imagination as to the result.

Thank you for reading my article. My books Medicare and Other Health Insurance and Appeal and Collection Letters for Medical Providers are on www.amazon.com

Copyright Linda Meckler 2022

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Prescription Drugs Goodrx.com and Singlecare.com

If you have medical insurance or do not have insurance it can become a horror story when the medicine you need costs out in space.

You need the medicine, otherwise, the doctor would not have prescribed it in the first place.

Sometimes, the medication can be replaced with another medication the same thing but costs less.

One medication can have many names and with each name a different charge.

But I have found out recently that there is hope. Two websites can help people like me and you that are on a small social security income.

The two websites are www.rx.com and www.singleacare.com

Now, these two websites need a little work. They can be downloaded to your cell phone.

On their website, you can find your medication and then you can scroll through the different pharmacies that take this website. You can print a coupon or use the one on your cell phone app.

This is a great option for you to know where to go and how much it is going to last.

I truly recommend these two websites when you get hit in the wallet for a ridiculous charge for your medication.

Thank you for reading my article. Let me hear from you.

Copyright Linda Meckler 2022

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Medicare Blunders For You To Prevent

If you have Medicare the way to find out if you are going to be charged for a procedure or for anything you use your medical insurance for is read this.

First of all, your doctor prescribes some type of procedure for you to have either in his office or at an outpatient surgery center. The doctor’s office receives the authorization for you to have this procedure.

What is it going to cost you?

You think because you have an HMO or other type of insurance that it will be covered.

Don’t assume anything.

The only way to find out for sure is to get the CPT and ICD codes from your doctor’s office  and call your insurance company. In this way, you should have an accurate amount that will be billed to you or it might not be exact but you will have an idea.

When the procedure is over and the bills come in you won’t stress over the copay that was the patient’s responsibility.

All this information is in my book Medicare and Other Health Insurances.

Thank you for reading my article. Copyright Linda Meckler 2021

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Medicare Is Tricky

Why is there mass confusion when it comes to Medicare? Even when you think you have a handle on it and understand your Medicare plan it can backfire on you.

I needed to go to the emergency room a few months ago for a minor problem with slivers of wood in my foot, but I needed to have this visit. The doctor spent ten minutes with me and I was fine.

I expected an emergency room copay of $85.00. That was supposed to be the only charge.

I received the bill and didn’t think anything about it. Then I received a bill for over a thousand dollars. What was this bill for?

This bill was for the physician’s bill which was sent from a separate billing service. I began to hyperventilate. The date of service which is what is the most important thing on the bill was missing. I called the phone number and found out the bill had never been billed to my medical insurance they didn’t have that information.

If you have read my book Medicare and Other Health Insurances it talks about this. After being on hold forever both at the billing company and my insurance company the bill will be sent to my medical insurance. But are they going to pay all of it? Will there be a co-pay left for me to pay?

When I talked to my medical insurance, I asked the question of why this bill when I was only supposed to pay for the ER visit.

  1. I thought it was an error.
  2. I thought I might have gone to a hospital that was not contracted to with my medical insurance. (I was told that I could go to any hospital for an ER visit. If admitted I needed to go to a specific hospital.)

When I asked my insurance company If this hospital was contracted with them? I didn’t get an answer. I will have to wait and see if it is paid or denied on my explanation of benefits and for what reason.

3. They didn’t have my medical insurance information.

Thank you for reading my article. Copyright 2021 Linda Meckler

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Red Hot Medical Bills

Believe it or not, you are not the only one who has medical bills. They seem endless and never-ending. You can get them from medical providers you have never heard of or thought of. Where did all these bills come from? If you have been in the hospital for a long-term stay expect a huge bill.

First, you have to break it down. What Date of Service (DOS) was billed and what was paid and what wasn’t paid and why – line by line.?

Let’s break it down. When you are admitted to the hospital for a scheduled surgery there is a facility fee. The doctors which are treating you have their fees. When tests are performed such as x-ray, MRI’s, lab, or any medication there are fees for these.

While in surgery there is an assistant surgeon and last but not least the Anthologist.  These are all the normal fees but of course, there could be other fees for your special needs.

Wow! these fees add up and your bill could be at least 30 pages long. When you have medical insurance your insurance company is billed. The insurance company whatever it is will usually pay 80% of the allowable. The allowable is determined from the contract your medical provider (the hospital) has with your insurance company. This is written off in a contractual agreement. It can be a different amount for different insurance plans. After the insurance has paid you are billed the balance of the bill if you do not have a 2nd insurance to apply it to.

If you have 10 bills from different Medical Providers this can get confusing and expensive.

Medical Bills are billed from the Date of Service (DOS) you were seen by a Medical Provider or in patient in a Hospital, etc.

There are all kinds of problems that can crop up which your medical insurance company will bring to your attention. This is where medical appeals come in.

Also, you must have some kind of understanding of how your insurance company works if you want to protect yourself and your family.

Now with people entering hospitals and are there for long or longer stays the medical bills are going to be astronomical.

Now you have to look at every Explanation of Benefits (EOB) line by line.

You have to make sure everything was billed from each individual medical provider. 

This is going to be complicated.

My book Medicare and Other Health Insurances will help you understand what the next step will be needed to get your bills paid.

Thank you for reading my article. Please feel free to read any of my numerous articles on various subjects.

Linda Meckler copyright 2009 updated 2021