I am on diability, that ive been on for a year. I wasnt old enough to recieve medicare right off the start....so I had to wait a year. My dr. adviced me to stay away from Humana. So I didn't even think about trying humanna.

Too many doctors are opting out of Humana. The restrictions on patient care reflect the company's cost cutting measures.
I'd get Medicare with a supplemental policy + a Rx plan. AARP UHC for both seems good.

I have a friend who is on Humana...I'm on the same program mona is on and have been happy with it, but there "is" a monthly pay out. Anyway, this friend has been raving about how great Humana is. Well, it would be that if you never had an illness. She and her husband are living on a small, fixed income and she has been diagnosed with cancer. So far, Humana hasn't paid almost eight hundred dollars of her expenses and she hadn't even gotten to the cancer diagnosis. But...last night she was still telling me how great Humana was....so I asked here...and got the answer I had been thinking about. Then...I went online and read up and, on my, they are really going to be in a world or hurt over this....what a shame. She has been old enough to be on Medicare or Humana for three years. Now, the bad part is going to show up, I'm afraid. We have found that Medicare, our supplement and the Part D for prescriptions has been wonderful.

NEVER let a doctor guide you on your insurance choices. They will steer you to the one that make THEM the most money. Most insurance companies have a set rate of payment for every proceedure. If a doc performs "X" and can get $100 rather than $30 for the procedure he prefers getting the $100. Some docs hate certain insurance companies because they are "slow payers" and they do not like to have to wait fo rtheir $$$$$. Doctors give priority care to patients with better a paying insurance policy, and that may be something to consider, but get your advice from unbiased sources.

"Doctors give priority care to patients with better a paying insurance policy,"

Not true. Maybe somewhere some do, but it's not fair to lump them all together. In the practice I work for, the doctors don't have any idea what insurance their patients have, only that they have a need to be taken care of. Yes, they will ask the patients if they have prescription drug coverage, so that they can prescribe the most cost-effective medications for them, but NEVER do they lower their standard of care in relation to a patient's insurance. EVER. As one of the office nurses, nor do I. Or any of the office staff. You're here, you're our patient, you get taken care of.

Bud, the scenario that you speak of does happen, but with a twist. For example: We had a heart patient that had a very abnormal heart rhythm. Had tried all of the medications and several procedures, did not work, and needed a procedure called an ablation to re-regulate his heart rhythm. He had had the procedure a few years ago when he had straight medicare and it was covered with no problem. In the interim he had joined one of the medicare HMOs similar to Humana. Even though our doctor recommended it, and even though it is part of the standard of care for his condition, it was denied. "Must try all other alternatives first". My doctor argued on the phone with the Medical Director of the HMO for 45 minutes and the resolution was that they were not going to pay for the procedure unless our patient was hospitalized and put thru several other (less costly) treatments that he had already tried and failed at. End result? After delaying his care by making a sick patient jump thru several unnecessary hoops, he ended up getting the procedure in the end after all.

I can't tell you how many hours I've spent on the phone trying to get nonformulary medications approved or procedures authorized for patients. So yes, I do believe that there is a game being played, but from *my own perspective* I believe it's being played by the insurance companies.

Just to play devil's advocate though, I will admit that there are insurances that the hospital (who owns our practice and a gajillion others) won't allow us to accept at all due to low reimbursement levels. So money is a factor, but not in the level of care we give. In the cases of those low reimbursing insurances, chances are that the insurance company has assigned them to one of their own doctors and the patients wouldn't be allowed to see us anyway.

Whew, after getting all of that off of my chest (LOL!) *from my perspective* I feel that Medicare plus a supplement and Part D is the better choice over the Medicare HMOs.

BTW I do agree with Bud about not letting a doctor guide your insurance choice. The doctor *could* be one that is contracted with the insurance company and looking out for that bottom line and not yours - I guess I just wanted to make a point that not ALL doctors are like that.

I'm going now to take a nice cold shower and have a beverage, lol!

april

Well said, April. I worked in a large medical clinic for years and we treated our patients the same if they were on Medicaid or private pay.

Thanks for an insider's perspective on the matter April but I am not understanding "I will admit that there are insurances that the hospital (who owns our practice and a gajillion others) won't allow us to accept at all due to low reimbursement levels. So money is a factor, but not in the level of care we give." If you won't accept them as a patient that is the WORST care that there is!!! None!

I at one time had Family Health Care, an HMO. We could only choose doctors from their list no other place. My experience was that when calling for an appointment they always had "something that week" until they learned that I had FHP. This happened with lots of doctors and quite often. Upon hearing 'Family Health Plan' suddenly it was going to be MONTHS to even see a doctor. One time when I balked at suddenly having to wait months when I had just been told "Thursday" only a minute before, the person told me the doctor didn't like FHP and wasn't "making any money off of FHP" and even said they were "Doing me a favor" by seeing me. (Actual quote.) I told them the doc should take his name off of FHP's list but she told me they were "Locked into a contract". So here I was paying $300/mo for FHP insurance (single coverage, not family) back in the mid-90s and was limited to seeing only doctors on their list, but who did not want to take anyone who had FHP. If I wanted to see a doctor I had to pay in full.

Another time a doctor called me and asked that I see him a his other clinic instead of the clinic I had been going to. When I asked it that would still be OK since the other clinic was not on my list of clinics my insurance company had on their list, he screamed at me that my insurance was for people who were "the lowest of the low" (Quote) and that "I would be better off quitting my job and going on welfare" (Quote) When I went to my next appointment he cancelled my surgury I had scheduled with him and everytime I called the office after that I was told no other appointments are available but to "keep calling".

I could go on ad on with other examples of this type of behavior experienced first hand. Someone told me that FHP paid the lowest of all and were also slow payers so doctors hated them. Live and learn. Or maybe die from lack of treatment?

My current health insureance operated the same way.

Like many Insurance plans they are a business and have stockholders, medical people and office personal to pay. I think when Hummana first started it was a good plan but as more and more people joined, there wss less profit so they adjusted and tightened up the rules. IF you are in Ca and some other states, and are near a Kaiser and never travel and choose a good Dr and are near a large center it is a good plan but you have to learn to right the system.
My relative has a Blue Cross suppliment and likes it along with Medicare, but not every BC suppliment in every state is the same.
You can go to a independant insurance agent and find out more.

I normally wouldn't of taken the dr's advice on stearing clear of hummana, but she is a long time friend of my family, my dad taught her in school as well. One of my husband's co-workers is looking for a different plan, because he chose hummana, and its not paying at all. These were the things I based my decision's on, and ive not been sorry for them. I took out along with medicare, also took a prescription plan called pathway, and i have no complaints, instead of my monthly prescriptions costing me 1800.00 a month, they now cost me around 140.00. I pay 22.60 for my pathway plan.

I am so glad I read this! I received a brochure from Humana yesterday and was going to research it today.Dh will be retiring the end of the month and will be losing his insurance with his job.He will be 70 in Feb. and only has part A with Medicare because of his other insurance.He will have to sign up for part B before the deadline. Without his insurance at work his monthly meds will be about $125.We hadn't decided if part D would help with that but from what everyone says I guess it will be worth it.I'm just worrying about how much it will lower our SS benefits.I only take 2 meds now that cost $4. each at Wallyworld so I'm not worried about part D.I already have part B.
maybee-What supplement do you have?

We have Blue Cross/Blue Shield...we pay a monthly premium, but it is well worth the cost. We signed up for Part D hoping that we would at least break even with it. All the hoopla before it came out cautioned that you should sign up or pay a hefty premium if you signed up later. We signed with the hopes we would at least break even...and it's been wonderful! I was reading up on Humana in our Iowa County and from what I could tell, you would be paying at least as much as we are paying if you want to coverage we have. If I had wanted more information, they said I would have to call and talk to them (and probably hear a sales pitch). This friend who has Humana has been singing its praises for several years now. But...she didn't have anything wrong. No premiums...to expense. Well, it all sounded way too good to be true and it was. She has been diagnosed with cancer and so far it hasn't paid $800 of her doctor bills...and those bills were incurred "before" the cancer diagnosis. There is a $5,000 out-of-pocket cap....these people can't afford $5,0000. What happens after the "cap" is what I would have to call and find out about..they didn't put that part in writing. So far, this hasn't hit her...she figures they saved that $800 by not paying premiums all this time. But..I'm sure reality will hit home when she has cancer surgery and has to go through chemo. We, too, had wonderful "company" insurance until we reached the age of 65. We have to pay more ourselves than we did then, but it hasn't been all that bad. I had cancer surgery and Medicare/Blue Cross/Blue Shield paid the whole amount...and I went to any hospital I chose. I also take advantage of the Wal-Mart $4.00 meds. When you meet your deductible, that $4.00 also goes now...I'm paying $1.00 for some of my medication at this point. But...I see no advantage to Humana unless you have nothing wrong and don't expect to "have" anything wrong. Now, I'm wondering if she can switch to a better plan when she sees how much this is going to cost her. As I understand it, with Medicare, you can buy "down", but you can't buy "up" once you start having problems. Of course there would be no advantage to buying a lesser policy. But..they don't want you taking the low-end one for less money and then getting the better one when you start having problems.....so, yes...we've been paying for the best they have, but I'm pretty sure it will be worth it in the long run as we get older....

"Thanks for an insider's perspective on the matter April but I am not understanding "I will admit that there are insurances that the hospital (who owns our practice and a gajillion others) won't allow us to accept at all due to low reimbursement levels. So money is a factor, but not in the level of care we give." If you won't accept them as a patient that is the WORST care that there is!!! None!"

I do see your point, however, if every practice was forced to accept all insurances and have no say in the matter, #1 the level of services available would suffer greatly, because somehow the bills still need to get paid (I'm talking the overhead it takes to run a practice) and #2 we would then be in a system similar to socialized medicine. Not that I think that's a bad thing, but it's not the way the system works now.

If enough patients complain about the lack of doctors on their plan to choose from, the insurance company (theoretically) has to increase their reimbursement rates which in turn gives patients more choice and access to a better variety of care. And also, no one forces people to choose one plan over the other. They know up front if the doctors they want are plan providers or not. So while you can say we are denying care, I can say patients chose the plan knowing we weren't providers. They are more than welcome to see us as a self-pay patient, but in the end someone does need to pay the bill (and we do give a 20% discount to self-pay patients). That's a fact of life, and I don't think that's being selfish or dishonest. Would a grocery store let you take groceries without payment because you left your checkbook at home? Or a gas station give you free gas because they don't accept your credit card?

Irregardless, I do believe the current system is broken, maybe beyond repair. All I can do is do what I can to make the little day-to-day things work and care for my patients :-)

april

The office I used to be associated with would spend countless hours arguing for needed Dx tests for the patients. Not until our MD would get on the phone, ask for the representaive's name and info because "if something dire should happen to this patient without this needed care I'd like to be able to supply this info to the family's attorney" did we get the authorization we needed.
The stress of constantly fighting for patient care was unbelievable!

Also, under the capitation system Primary Care MD's are reluctant to refer to specialists, so referrals are hard to get from HMO's.

I personally have UHC care, Plan J, as a supplement along with AARP Rx plan.
I take only Lipitor at this time, but if I signed up for the Rx plan at a later date I'd pay a higher monthly premium. So I signed up now, figuring I'd be on more meds later.

I was paying $1400 a month before I signed up with Medicare.
Now I'm paying about $450 and Plan J covers just about every scenario, including out of country coverage, I might ever encounter.

Bud, I don't think doctors are practicing medicine just for the money; they truly care about their patients. Of course, there are a few exceptions to the rule.

However, I don't think they should be working for free either. I personally know of several, wonderfully dedicated doctors who went several months without salary because of poor reimbursements from certain insurance companies. They finally closed their practices and moved to small towns in other states where there were no HMO's.

Unfortunately, we usually get what we pay for. While medical care from HMO's is adequate, the American patient wants and demands the latest in medication and procedure. HMO patients will be seen by a doctor for treatment but since these practices have high patient volumes at low reimbursements it may not always be to their liking. Treatment will likely be standard and perhaps not the latest, costlier options.

I'm not sure what the solution is, but I don't think socialized medicine is it.

My last years working I saw many patients coming in for insignificant complaints because they only had a $10 office co-pay and they wanted their money's worth with a Rx that came with a $5 co-pay. Multiply this times millions every year and you'll have an idea of how much money is wasted on "entitled" visits. It cuts down on the available monies for those patients who truly need the care.

But, I digress. Let me stop here.

Mona, amen.

April, maybe I was not clear in my post. I am not saying that docs should accept ALL insurance from everyone. I am saying that the doctors who contract with an insurance company should treat those patients the same as all the rest. They should not give unreasonable priority to the higher paying patients AKA "the money makers". If a doc charges $60 for an office visit and lists himself with an insurance company who will only pay him $12 for an office visit, they shouldn't base appointments on what kind of payment they will receive. If they think they are worth more than the $12 they will receive from the HMO then they should not contract with them.

The analogy of 'expecting free groceries' due to "leaving your check book at home" doen't jibe. If a patient pays insurance premiums and can only go to a doctor on the list, the listed doctor should treat those patients the same as all the rest, otherwise he should not have contracted with that particular insurance company. If a gas station does not take a certain credit card it is because they did not contract with that particular credit card company and would have no obligation to do so. That is easily understood.

Being IM on dialysis they hooked me up with medicare A&B.MY husband has Highmark blue shield.The medicare just raised my fee because they said it depended on our tax forms.Hubby is making too much money.It went from 95 to 142

Hmmmmm....I don't think Medicare is based on how much you make...maybe it differs from state to state. But..my low income friend is paying the same amount we are paying. This is not the friend who is on Humana....she wasn't paying "any" premiums, but I'm thinking as this plays out, they are going to be in a world of hurt with debt. We have Plan F with a supplement. We are paying much, much more than we did before we hit sixty five, but we had company insurance at that time. You can't "plan" on being healthy all of your life...even if that is the case at present time. This friend was so sold on Humana that I began to wonder if I was missing something, so I began reading up...thought I might still be missing the point, and that is the reason for this post. From what I can glean from their website, she is going to be well into debt before this illness is over. If she had chosen one of their plans with premiums, she would have been paying nearly as much as we pay. She went three years with no premiums, but they didn't bank that "no premium" money in case of an emergency such as this. Now...around here..the ones who have no insurance or doctor, go to the ER...which is another whole can of worms to open up. But...I was just wondering if Humana was as wonderful as she thought it was....it's not

Yes, in Pa, I have seen medicare supplimentary payments go up with income. There is an income threshold, with BC/BS and Highmark, where the payments are increased. It is calculated on the prior year's total income (wages and passive).

In FL the Medicare premiums are adjusted to income as well.

"April, maybe I was not clear in my post. I am not saying that docs should accept ALL insurance from everyone. I am saying that the doctors who contract with an insurance company should treat those patients the same as all the rest. They should not give unreasonable priority to the higher paying patients AKA "the money makers". If a doc charges $60 for an office visit and lists himself with an insurance company who will only pay him $12 for an office visit, they shouldn't base appointments on what kind of payment they will receive. If they think they are worth more than the $12 they will receive from the HMO then they should not contract with them."

This is what I was responding to, Bud:

"Thanks for an insider's perspective on the matter April but I am not understanding "I will admit that there are insurances that the hospital (who owns our practice and a gajillion others) won't allow us to accept at all due to low reimbursement levels. So money is a factor, but not in the level of care we give." If you won't accept them as a patient that is the WORST care that there is!!! None"

My point was that we don't even contract with them, but it seems this thread is becoming argumentative, so I'm hoping that we can just agree to disagree. It's been too long of a day.

april

those coming close to using medicare need to do alot of research on it. most leading financial analysists are predicting a crash in medicare part A w/in 10 yrs. the warned downfall of social security was really more about medicare/medicaid going bankrupt. alan greenspan & warren buffett have taken up this cause, advising boomers and others to get private insurance supplements if not full coverage ahead of the collapse. buffett's idea is that payroll taxes need to start being calculated in income over $95K to help cover SS (bankrupt w/in 20 yrs) and medicare/medicaid but this measure is barely acknowledged in he white house and not expected to fare well in the latest new tax bill coming up for review. it doesn't look like there will be any fix in time...and it's no wonder w/ spending in those programs out pacing incoming revenues. ~ liz

"My point was that we don't even contract with them, but it seems this thread is becoming argumentative, so I'm hoping that we can just agree to disagree."

OK. I understand what you meant now. I misunderstood your other post to mean that you turn away those with insurance the hospital doesn't prefer even though they contracted with the company. And it HAS been my experience that some clinics have this as an unofficial policy. I'm not trying to be arguementive, just offering another perspctive based on personal experience.

BTW The state of Wisconsin shut down Family Health Plan. It was a scam. Everybody lost money on it. both the doctors and the subscribers.