Health Care Insurance -- watch out for last minute changes

3 years ago

Word to the wise -- If you are signing up through open enrollment, you might want to make another check of the providers you plan on using to make sure they are STILL in network. Apparently one of the three local hospitals just dropped from my plan -- as of today but effective 1-1-22. Only found out because DH was double checking and they were not there so he called. The one that says they are no longer in network as of 1-1-22 is still showing all the other locations, including the main location in the Houston Medical Center, as in-network. I'm sure other folks have checked and signed up with one set of facts only to find something may be different when they need it. These changes should really happen BEFORE open enrollment begins.

Featured Answer

bpath

3 years ago

Thanks for the link, teresoza. Interesting that it is the Centers for Medicare and Medicaid Services but at the bottom of the explanation, is this:

“The rules don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE because these programs have other protections against high medical bills.“

Sort by:Oldest

Comments (8)

Fun2BHere
3 years ago
Thank you.
0
lascatx thanked Fun2BHere
bpath
3 years ago
last modified: 3 years ago
Insurance is so frustrating.. You have to check on every single thing. I got a bill for my mammogram this year, because I had it done at the one hospital in my in-network system that is NOT in network, so it wasn't covered. How can that be? Aaargh.

And yes, you have to check every year. One year I went in for an appointment only to find they were no longer in network. I offered to pay out of pocket, they said they can't do that. Why not? Because they don't know how much it week cost. Me: Of course you do. They: No we don't. Finally they agreed to see me long enough to renew my Rx.
lascatx thanked bpath
Related Discussions
Long Term Health Care Insurance
Q
Comments (5)
Three thousand a month is about right for private nursing home care--or was. Some of the upscale places can cost even more. If you can afford the insurance--it makes good sense--if not you may want to consider other alternatives. A family member, in Louisiana, now deceased, gave away his property--everything--to the kids and retained usufruct until his death. That solved part of the problem of worrying about nursing home expense to the extent of his possibly losing the results of a lifetime of work--if leaving it to your heirs is what you want to do. I believe at the time that the exclusion period was six months, i.o.w. the property had to have been out of his ownership for at least six months or they could go back and reclaim it. That period of time may have changed. Only a good lawyer is going to know for certain. Cash is a different ballgame altogether. Single premium life insurance policies can sometimes provide a means of transferring any cash that isn't deemed necessary to maintain a lifestyle--if leaving it to your heirs is what you want to do. If there's a sizeable amount of cash involved then you can use this as leverage to insure that those gaining the real property "behave" since the beneficiary can be changed up until practically the moment of death. Talk to a financial planner (a CPA with experience in the field) and a lawyer.
...See More
Health insurance for seniors
Q
Comments (26)
Regardless of age and health issues she is paying entirely too much. Go to an insurance agent that sells Medicare Supplements and Medicare Part D (prescription drugs). The Insurance company cannot refuse to enroll her the first time for any reason. Also, check with an agent for dental coverage. I am 69 and pay about $30 per month with Aetna for dental and $120 (Plan G) for the Medicare Supplement that pays the balance after Conventional Medicare Part A and B (80%). Depending on age the Medicare Supplement, Plan F that pays all claim amounts (if Medicare pays for the procedure) with no copay or deductible should cost about $100 per month. Likely, you will find that aetna currently has the lowest price. Regardless of the company, all providers in her state must offer identical coverage with the premium being the only variable. Plan G will even be a lower price than Plan F with the only difference being she will pay an annual Medicare deductible for 2013 of $147. Medicare part D pricing will vary but Medicare has an excellent website where you can enter the drugs taken and you will find the out of pocket pricing. I now pay about $30 per month with First Health and pay nothing for Tier 1 generic drugs. I have changed providers now 3 times due to lower prices offered by another provider. I shop every year! The Part D prescription various amounts depending on the provider and plan chosen. In general, it covers about 40% of drug costs unless it is a tier 1 generic drug. Be careful that you do the research because one can be screwed. So, with the Medicare Supplement, Medicare Part D and dental insurance, the monthly cost should be about $160. Keep in mind that she can pay much more if she falls in love with an insurance company as she already has. She is likely paying a 3% administrative fee to her past employer for Cobra. Cobra should only be a temporary alternative until one is 65 and qualifies for Medicare.
...See More
How do you handle the high cost of health care insurance?
Q
Comments (29)
Chelone, I'm sad to hear that your mother has had to cope with some cancer. It is hard to deal with that - even if one's trouble is of one's own making. My family has a history of weak lungs, which I share. I started to smoke at age 16 and after a few months decided that I didn't care for either the taste or, being frugal, the cost - so quit. Now enjoying good health at age 75, I'm very thankful that I had the common snense to do that. And often suggest to others that I hope that they decide to quit, so increase their chances of enjoying such a prolonged and healthy retirement, as well. I try not to come off judgementally about it - and few have given a surly response. Some have thanked me. Hayjud, I hope that you were not upset by my rather joking and somewhat smart-assed suggestion that you consider moving to Canada. Seriously, have you considered taking on a part-time project to produce some income? The nice thing is that you are your own boss, you can do the kind of thing that you are interested in and good at, and can do whatever you choose at your own speed. You don't have the pressure to produce enough to live on - as you had planned to get along on the retirement income that was already in place. I subscribe to a newsletter that discussed some of the issues related to that just this week - can send you URL if you wish (don't know it at present - but can look it up). On the internet might be possible. Some sell on ebay, etc. I feel that it would be preferable if you have knowledge that you can sell, whether by newsletter, ezine, etc. Possibly even personal consultation, whether on the internet or even by phone. Easy to send the messages - better than having to wrap and ship products, I think. I find that it is difficult to find people to reply showing interest in your offer, let alone subscribing, for there is so much material there already. Many don't like what they see and have been turned off regarding the whole thing. I have an idea that might be of interest, which I've checked out around here, but have minimal information that might be helpful to you. Good wishes as you proceed with your retirement. I hope that you enjoy it and have the good helath to be able to do a number of the things that you've looked forward to doing for a number of recent years. joyful
...See More
Bummed about health insurance!
Q
Comments (36)
As roarah says, all states are not equal. I live in a state whose gov. has done everything he could to stymie the ACA & refused to expand Medicaid - leaving many of our citizens w/o access to coverage. Also, our insurance commissioner is reportedly prohibited from regulating the insurance 'providers' - essentially allowing them to gouge consumers. If it were not for the ACA, I would not have insurance (had none for over 30 years before now) & I've already made good use of it. My individual plan is costing approx. $4400/yr, but I'm paying only about $800 of that w/ the subsidy. Not to let anybody off the hook, but I think the biggest culprit is medical costs - which continue to balloon out of control, it seems. Insurance providers, & ultimately we, are definitely paying through the nose for services & prescriptions. I was recently in a hospital room for about 6 hours - not even an overnight stay & no meals & the charge for that my ins. co. paid was $23,000! Has anyone else heard about the new push to require providers to disclose prices? The prediction is that this may result in lower costs - eventually. Right now, the $$ charged for a procedure can vary as much as 70% or more... http://www.npr.org/blogs/health/2014/02/12/276001379/elusive-goal-a-transparent-price-list-for-health-care Oh & love him or hate him, I recently heard a good 1 from Ralph Nader: isn't it ironic to be calling the folks who gouge everyone on medical costs 'providers'?
...See More
Related Professionals
Tampa Furniture & Accessories · Ventura Furniture & Accessories · Carlsbad Furniture & Accessories · Rogers Furniture & Accessories · Carson Furniture & Accessories · Queens Interior Designers & Decorators · Wareham Interior Designers & Decorators · Clive Architects & Building Designers · Four Corners Architects & Building Designers · Makakilo City Architects & Building Designers · Kaysville Home Builders · Lewisville Home Builders · Orange County Professional Organizers · Sharonville Professional Organizers · Roseville Professional Organizers
terezosa / terriks
3 years ago
bpath - starting January 1st the "No Surprises Act" goes into effect, meaning that you shouldn't receive any more "surprise" bills because a provider, such as an anesthesiologist who is not in your network, even though the surgeon and hospital is.

https://www.cms.gov/nosurprises
lascatx thanked terezosa / terriks
gsciencechick
3 years ago
For some crazy reason my Synthroid is no longer covered though it is written ”dispense as written.” At least the pharmacist was able to use GoodRx or something like that which only cost me about $10 more than I was paying for a 90 day supply.
0
lascatx thanked gsciencechick
PRO
MDLN
3 years ago
@gsciencechick, suggest appeal to your insurance company, as I'm sure you know, they are trying to save $ by taking brand off formulary and substituting w/ generic. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106520/

https://pubmed.ncbi.nlm.nih.gov/34322821/

https://pubmed.ncbi.nlm.nih.gov/31485974/
0
lascatx thanked MDLN
bpath
3 years ago
It has happened with some of our prescriptions that GoodRx is cheaper. I also use it for the cat.
0
lascatx thanked bpath
lascatx
Original Author
3 years ago
In the last year or two, all of my prescriptions went up in cost and one went off the formulary and was not covered. Their appeal required me to jump through a number of hoops, including having tried at least 3 other drugs in the same class unsuccessfully, and even with the appeal and approval, the "covered" cost was higher than both Costco and GoodRx. Over $500 for a generic -- got it down to $150. I'm glad it isn't something I need all the time, but when I need it, I need it and I've had so many problems with other meds insurance has forced me to try that I am unwilling to go there again.

Bpath, the change in hospitals occurred this week -- they were there when I signed up during this open enrollment period and gone yesterday. I understand that they may change year to year, but once open enrollment has started, I don't think the plans should be allowed to make such significant changes. People make potentially life changing choices based on what they find in their searches -- and it never would have occurred to me that the providers in and out of network could be changing even as I am making my choices. That one change is not enough for me to change plans, I plan to verify everything next week in case there are other changes that would be.
0

Health Care Insurance -- watch out for last minute changes

bpath

Comments (8)

Fun2BHere

bpath

Related Discussions

Related Professionals

terezosa / terriks

gsciencechick

MDLN

bpath

lascatx
Original Author

COMPANY

BUSINESS SERVICES

GET HELP

CONNECT WITH US

Health Care Insurance -- watch out for last minute changes

bpath

Comments (8)

Fun2BHere

bpath

Related Discussions

Related Professionals

terezosa / terriks

gsciencechick

MDLN

bpath

lascatxOriginal Author

COMPANY

BUSINESS SERVICES

GET HELP

CONNECT WITH US

lascatx
Original Author