Margali's Griffin Wood Ranch

We have an HMO "cadillac plan" with no co-pay. When we reached Medicare age we wererequired to go on Medicare as a primary. Our HMO paid 100% of everything else. We are getting billed for a co-pay from Medicare. Our HMO is trying to take care of it but there is no one answering phones in the Medicare office. It is only about $20 but DH is peeved and won't pay it on principal because Medicare were supposed to send the bill to the HMO to start with.

Ridgetop said:

We have an HMO "cadillac plan" with no co-pay. When we reached Medicare age we wererequired to go on Medicare as a primary. Our HMO paid 100% of everything else. We are getting billed for a co-pay from Medicare. Our HMO is trying to take care of it but there is no one answering phones in the Medicare office. It is only about $20 but DH is peeved and won't pay it on principal because Medicare were supposed to send the bill to the HMO to start with.

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I'm not looking forward to going on Medicare. They messed up so much of Ron's medical billing.

Cassandra had emergency surgery on 3/14 and Cook's submitted claims to United Health Care insurance on 3/21. Several claims were processed by 3/23 and Cook's Children portal shows the UHC payment. The 2 claims totaling $4,744 processed on 3/26 by UHC are "Outstanding" in Cook's system with $0 UHC payment. The $31,651 main surgery claim is still "Pending Insurance". They sent me bill for the $4,744 on April 1st due April 29th. It hasn't even been 30days since surgery!!!

When I called to protest, they said "Send the EOBs and we will review. The bill is still due April 29th though". Doctors are great, medical billing has been as well till this debacle.

fuzzi said:

I'm not looking forward to going on Medicare. They messed up so much of Ron's medical billing.

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My experience with Medicare has been WONDERFUL..... Literally... I went on Medicare A & B..... then got the supplement Plan G...(maybe plan F? One is no longer offered...). Medicare costs directly out of my SS check..... Then I pay 155/mo for plan G. I have it done directly out of cking account. Plan G started at $88 ? first year , has gone up every year... to be expected...
BUT..... I pay ONLY $325 year deductible..... that is IT....No copays, No dr office payments....NOTHING, Once I meet that... everything else is paid through Medicare or the supplement... I never see bills or anything... It has covered ALL my medical expenses for the ankle replacement in Feb 2020, 17 days in a nursing home/Rehab that was wonderful, PT for 6 months plus ...... Both knees replaced in late 2021, less than stellar rehab for 14 days, and over a year for PT.....Once I pay that initial deductible... that is directly billed from whomever I have seen at the beginning of the calendar year...
I also got the cheapest simplest drug plan since I take nothing regularly..... costs me about $100 year and the last 2 years have been "free"... and I called them to make sure that was right... If I had to take anything like high blood pressure meds or diabetic or cholesterol or something then I would shop but hopefully that will not be a consideration....
At some time I may do what @Mini Horses did and go with a Medicare advantage plan.... covers alot less if you need major stuff like the joint replacements.... but covers more on the day to day stuff like OTC medicines and such...she can chime in on that.... and costs very little in comparison. I am not well versed in them... but my ins lady at work advised me as I was getting close to 65... and I told her about the replacement needs.... and she said this is what I put my husband on when he retired from work... and this is what we paid out and what all it covered... Hence the PLAN G. Since there might be a shoulder deal in the future... I am not going to change... at this time...

I had ins at work when I was full time... and it was costing me about $150 a month.... had $6000 deductible..... so what I have now even at that cost.... is cheap in comparison.....If I had to deal with medical billing and other stuff I would probably go nuts... The cost of the medicare is about 135/mo out of my SS check... plus the 155 supplement... is say $200/mo.... that's $2400/yr.... add my deductible of $350 .... $2750 a year... I was paying $1800/yr and then had to come up with $6000 deductible total.... I'm still much better off....

My Medicare is $105. MO on advantage plan...(It's $175. For reg A&B Medicare, no drug coverage). Both have some co-pays. So, that only happens if you go to a doctor, urgent care, hospital. I haven't, so not an issue. If I did, I'd just pay the co pay, they are $10-50, from visit to urgent care, on this plan. More if hospitalized, $325 day, first 5 days. I use BCBS a good provider.

For 11 yrs I pd for reg Medicare & never a claim. Pd $ every month, direct from SS ck, used nothing. Went to advantage plan -- for less cost. Still no medical claims...annual physical is free. BUT now dental & vision is covered, up to limits on plan. I use both of those. And I have a debit card for OTC buys. I now receive something for my monthly payment. I have no drug coverage because I haven't had a need for an RX in over 25 yrs. Figure I can pay if one is needed. Knowing my health helped me make the decision. 2024 pd $1260 premium, received $1988+ dental, $328 glasses, and spent $300 otc. No out of pocket. There's annual out of pocket limit, $6k...if major health needs.

Now we've turned this journal into Medicare info

Mini Horses said:

My Medicare is $105. MO on advantage plan...(It's $175. For reg A&B Medicare, no drug coverage). Both have some co-pays. So, that only happens if you go to a doctor, urgent care, hospital. I haven't, so not an issue. If I did, I'd just pay the co pay, they are $10-50, from visit to urgent care, on this plan. More if hospitalized, $325 day, first 5 days. I use BCBS a good provider.
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Now we've turned this journal into Medicare info

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I don't mind, it's helpful!

You and @farmerjan are from the same state, maybe that has something to do with it?

@Mini Horses, what's your Advantage plan?

There were three options in this area: AEtna, Humana, United. Humana was the only one that offered coverage on Ron's prescriptions, so I went with it. No monthly cost, in-network with local providers, hospital. Good. One month later hospital drops it from in-network, and since all the providers in the area are part of the hospital network everything but Ron's prescriptions were no longer covered.

So naturally I feel burned.

@farmerjan I had a hip replacement 16 years ago, expect another replacement in the future if I live more than a couple years. Your information is good to have, thanks.

@Margali I apologize for hijacking your journal thread. I will take my Medicare discussion elsewhere.

Sorry, @Margali ... you are no where near "Medicare Age"..... we took over your thread on the kids health situation, and the miserable situation with Medical Billing...

It's fine. The good news is Cook's Children updated their billing after I complained. And UHC shows we met our out of pocket maximum. So the rest of the year is "free".