Category: Medical Insurance

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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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Elementor #1790

 

 

 

 

Understanding Medical Insurance Contracts

What most people do not understand is the way medical insurance works. In plain English, it works by insurance contracts. The insurance companies are the ones to blame for this big mess in the healthcare system. They make all the money and love to keep their clients confused as to what it is all about. When the knife slices the reality of what it is and what it isn’t paying for it is too late.

A Medical Provider is a doctor, laboratory, hospital, ambulance company, x-ray lab, etc. Each medical provider signs a contract with each individual insurance company they want to be contracted with.

Every contract is different. With a doctor, it would be considerably different than it would be with a hospital.

This contract simply states that the medical provider will accept this insurance or that insurance and receive a percentage of payment.

Now with each insurance company the percentage changes.

Employers: The employers or business owners sign a contract with the insurance companies. This is where it becomes confusing. There are many different plans with the insurance company.

Medicare

Straight Medicare-

You pay 80% of your bill. 

You may have a secondary insurance. 

HMO  – This is where you have a PCP or Primary Care Physician. You need a referral to see a specialist and authorization to have surgery or some sort of test. These medical providers you will be scheduled with are within your medical contract. You pay a copay with each visit.

PPO – This is when you can make your own appointment with a specialist. You pay more for this insurance and you can go out of the contract of medical providers but it will cost more.

Straight Commercial Insurance – This is when you pay your contracted rate and a percentage of what your insurance doesn’t cover.

This is why when patient A goes to Dr. Brown and has a general examination of blood pressure and a blood test. The insurance will pay a certain percentage and the patient will be charged the rest after something has been adjusted off per the contracted rate.

Patient B same thing, the same doctor. But when patient B receives his Explanation of Benefits (EOB) from insurance the rate the patient is expected to pay is different.

This is because of the name of the insurance company and the type of plan that was picked.

FOR MEDICAL PROVIDERS

My book Appeal and Collection Letters is for you.

If you have any questions please contact me on my website www.lindameckler-author-artist.com

Linda Meckler author of over 25 books and worked in Medical Insurance Billing for over 25 years. Her book Medicare and Other Health Insurances.  Explains in simple English how Medical Insurance Works, sample Appeal Letters, and much more.

Copyright Linda E. Meckler 2013 updated 2023

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Social Security What A Joke

What do you think seniors? Can you live on the amount of money you get from Social Security monthly?

The amount of Social Security stays the same. But everything else goes up.

Food has gone up so high in price I don’t want to go into the grocery store unless I have no choice.

People have to eat to stay alive.

They need a home. Whatever that means to you.

They need medical care.

They need dental care.

They need clothes.

They need to be clean.

This sounds so ordinary but is it.

Today thousands live on the streets. All these necessities evaporate in their search to stay alive.

Politicians who are running for office love to mouth off about cutting Social Security and Medicare.

Keep it up and you won’t get elected.

There are more living (voting) seniors alive than ever before.

Thank you for reading my article.

Linda Meckler, author  copyright 2023

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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

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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?

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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Drug Check

When you are picking up your drugs from the pharmacy these are the things you should check before you take them home. This could be a life or death drug mistake.

Make sure your name is spelled correctly. There are many people with the same name or others with similar names.

Check the date of birth on the bottle. Is it yours?

Check the name of the drug. Is this what you take?

Check the amount of the pills in the bottle.  Is it correct?

Check to see if the refills have been applied to your drug.

Yes, the label is computer generated but humans put the information into the computer and humans make mistakes.

In most cases, your prescription is emailed to your pharmacy without anyone having to read the doctor’s handwriting. But there are still handwritten prescriptions and the person reading it could read it wrong.

BE AWARE.

Thank you for reading my article.

Copyright Linda Meckler 2021

 

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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