Another MA article.

[axeman462]

??????

This poor info about Cleveland Clinic has been circulating for well over a decade, I think it was part of "training" in medigap against MAPD.... but it's not even close to accurate.

Cleveland Clinic (facts)

Medicare Advantage Plans
The federal government’s health insurance program for people ages 65 and older, and certain younger people with disabilities or kidney failure.

• Aetna Medicare Plan (Golden Choice).
• Aetna Medicare Plan (Golden Medicare Plan).
• Anthem BCBS Medicare Preferred.
• Anthem BCBS Medicare Select.
• Anthem BCBS Senior Advantage.
• AARP Medicare Advantage (Through UnitedHealthcare).
• AARP Medicare Advantage Choice (Through UnitedHealthcare).
• AARP Medicare Advantage Flex (Through UnitedHealthcare).
• AARP Medicare Advantage Patriot (Through UnitedHealthcare).
• AARP Medicare Advantage Optum Care (Through UnitedHealthcare).
• CareSource Medicare Advantage.
• Cigna Preferred Medicare (HMO).
• Cigna True Choice Medicare (PPO).
• CommuniCare Advantage I-SNP/C-SNP.
• Devoted Health.
• Fida North Shore-LIJ Medicare – Cleveland Clinic main campus only.
• Humana Choice Medicare Advantage.
• Humana Cleveland Clinic Preferred.
• Humana Gold Choice.
• Humana Gold Plus.
• Medical Mutual of Ohio Medicare Advantage.
• Medicare A, B, C, and D.
• Medigold – Union Hospital Only.
• Molina Healthcare Medicare Advantage – Mercy Hospital Only.
• Paramount Elite.
• Perennial Advantage I-SNP/C-SNP.
• PrimeTime Health Plan.
• Provider Partners Health Plan (PPHP) I-SNP.
• SummaCare Medicare.
• The Health Plan SecureCare MDCR HMO.
• The Health Plan Secure Choice.
• United Healthcare Dual Complete SNP.
• United Healthcare Medicare Advantage.
• United Healthcare Medicare Complete.
• United Healthcare Medicare Complete Essential.
• United Healthcare Medicare Complete Choice.
• UPMC for Life.
• Valor Health Plan I-SNP.

I have had MAPD clients using Cleveland Clinic for over a decade. But it always pops up in conversations like this one...

Yup, Cleveland certainly does. I have clients in SoFlo that use them as well with MAPD.

Also MD Anderson also accepts MAPD

Also Mayo in Jacksonville, accepts some MAPD as OON

Also John Hopkins accepts some MAPD as OON

He also doesn't mention how other great hospitals such as Moffit or UF Shands accept MAPD.
I could also go about how other world renowned Medical Facilities accept MAPD like Mount Sinai, Bascom Palmer Eye Institute, or NYU Langone, and several others.
But the MAPD bashers would rather just fixate on a few rare instances where certain MAPD plans are not in network. While ignoring all the other options out there. And conveniently forget to mention that the vast, vast majority of people could never afford to travel across the united states, and rent a place to live for weeks on end while getting the care needed at these super high end facilities.
But yes, let keep on talking about the super rare instances where someone is willing to travel 600+ miles to a healthcare facility for care.

Most people only travel to the closest healthcare facility with a decent reputation and get the care there.

 

[straightnochaser]

Yup, Cleveland certainly does. I have clients in SoFlo that use them as well with MAPD.

Also MD Anderson also accepts MAPD

Also Mayo in Jacksonville, accepts some MAPD as OON

Also John Hopkins accepts some MAPD as OON

He also doesn't mention how other great hospitals such as Moffit or UF Shands accept MAPD.
I could also go about how other world renowned Medical Facilities accept MAPD like Mount Sinai, Bascom Palmer Eye Institute, or NYU Langone, and several others.
But the MAPD bashers would rather just fixate on a few rare instances where certain MAPD plans are not in network. While ignoring all the other options out there. And conveniently forget to mention that the vast, vast majority of people could never afford to travel across the united states, and rent a place to live for weeks on end while getting the care needed at these super high end facilities.
But yes, let keep on talking about the super rare instances where someone is willing to travel 600+ miles to a healthcare facility for care.

Most people only travel to the closest healthcare facility with a decent reputation and get the care there.

You didn't know? Everyone who gets cancer is just able to uproot everything and go to the best cancer centers in the US... Happens all the time.

 

[sshafran]

Love em' or leave em', there's a trend a' brewin' with MAPDs. Time will tell what changes are coming, but there most certainly will be changes. $140B worth.

As an American I think it's stupid that they're [ie we are as taxpayers] essentially subsidizing overpriced cough drops via OTC benefits and golf green fees and essentially paying for the dentists' new Mercedes cuz Hilda has $2,900 available, so you know there are crowns to put on... Don't want to waste it!

But .... It's not going away. They vote.

 

[axeman462]

As an American I think it's stupid that they're [ie we are as taxpayers] essentially subsidizing overpriced cough drops via OTC benefits and golf green fees and essentially paying for the dentists' new Mercedes cuz Hilda has $2,900 available, so you know there are crowns to put on... Don't want to waste it!

But .... It's not going away. They vote.

yup.

 

[somarco]

Sorry for mis-understanding --- but it certainly seemed like you were implying that if a friend got cancer, and that friend had an MA plan, that the friend would not have the choice to go to Mayo, or MD Anderson, or Cleveland Clinic....etc.

Mayo & MD Anderson as well as Memorial Sloan Kettering. do have limitations and may create challenges for some folks with MAPD. Information below is direct from their websites. You can interpret it anyway you want.



MD ANDERSON #1


If you are enrolled in a managed care plan (HMO, PPO or POS), your treatment at MD Anderson may be covered by insurance. Before scheduling an initial appointment, please call your health plan/insurance company and ask if you have access to health care services at MD Anderson. We encourage you to refer to Questions to Ask Your Insurance Company when speaking to your insurance provider.


If MD Anderson is not a participating provider, you may still be able to receive treatment here. Contact your insurance company and ask about obtaining authorization. It is important to note that some benefit plans utilize what are referred to as "narrow" or "limited" networks; that is, they further narrow or limit the choices of doctors and hospitals that their customers can use. Often, these networks exclude MD Anderson. Additionally, some plans, such as HMO’s, have primary care physician referral and/or other authorization guidelines.


Your MD Anderson patient access specialist will help you obtain the full benefit from your insurance plan by:


Answering your questions about insurance verification and/or prepayment requirement

Responding to insurer requests for additional medical information.

DISCLAIMER: MD Anderson's participation with any product or insurance plan is subject to change without notice. Additionally, insurance companies offer a variety of plans and may change the names and benefits at any point. A patient’s level of coverage depends on the specific benefits outlined in their plan.


To ensure that MD Anderson and its physicians are in-network, it is the patient's responsibility to verify that MD Anderson is a participating provider and their benefit plan allows them access as of the day of a visit and/or admission. Please contact your insurance plan to obtain this information.


[EXTERNAL LINK] - Insurance Plans





Revised 2/23/2023


MEMORIAL SLOAN KETTERING #2


When you’re coping with a cancer diagnosis, insurance may be the last thing you or your loved ones want to deal with. But it’s important to understand your options. Our insurance specialists are here to help you make sense of your insurance and payment questions — whether you are considering coming to us as a new patient or you are already in our care.


Insurance Plans

MSK has relationships with many common healthcare providers. Even if your insurance company does not have a relationship with MSK, or if you don’t have health insurance, we encourage you to call us. There may be other ways we can help, for example, through our Financial Assistance program.


Before contacting your insurance company, you may find it helpful to review Questions to Ask Your Insurance Company.


Certain plans from the following insurance companies have relationships with us (and all of our doctors). Please review this list carefully. Call us if you have questions or need help. Insurance companies offer many different types of plans, and some may not include us.


If you have an EPO or HMO insurance that is not on the list, this means MSK is not in their network. Before you make your first appointment at MSK, you must see your Primary Care Physician and get an out-of-network authorization for a comprehensive consultation. MSK must receive this authorization before any appointments are scheduled.


[EXTERNAL LINK] - Insurance Plans



MAYO CLINIC #3


Your Mayo Clinic doctor will decide which procedures, tests and other consultations you may need. However, many health plans require pre-certification and sometimes predetermination of medical necessity prior to care being rendered. In addition, some services may not be a covered benefit for some plans. Investigating coverage requirements and limits can take up to six weeks, and some services require pre-certification staff to supply photos and medical necessity information to your insurance company.


For example, services that may require pre-certification include outpatient and inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans, and colonoscopies.


Patients are responsible for knowing the pre-certification requirements of their health plans. Mayo Clinic highly recommends that you contact your insurance company to determine benefits and coverage for the Mayo Clinic location at which you plan to be seen.


Managed care plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) may deny or reduce benefits if care is obtained outside of the established network or authorization of the plan.

Patients' plans that require prior authorization or pre-certification may provide only a reduced insurance payment if not previously authorized. In such cases, the patient will be financially responsible for more — possibly all — of the provided services.

A pre-service deposit may be required for nonauthorized visits.

To avoid paying a pre-service deposit or experiencing either denial of payment or a reduction of benefits, Mayo Clinic highly recommends you contact your insurance carrier prior to services to determine plan requirements or limitations to receiving care at the Mayo Clinic site at which you will receive services.


[EXTERNAL LINK] - Insurance approvals: pre-certification and prior authorizations - Mayo Clinic

 

[axeman462]

Love em' or leave em', there's a trend a' brewin' with MAPDs. Time will tell what changes are coming, but there most certainly will be changes. $140B worth.

It's the future of all healthcare in the United States. Give it time.

 

[Yagents]

Mayo AZ does not accept mapd. Period. They even send out letters to patients warning them not to choose mapd if they want continued care.

If my sick clients are stuck on a med supp (in a good place), because of underwriting, they know it beforhand and glad they are stuck. Most mapd clients don't understand they can't move back to med supp...that's a shame

 

[Fisher]

Except this post was from USN about the top 100 cancer centers. MAPD only came up with the @Fisher post about City of Hope, which he later explained that his TWO clients did not have a problem getting treatment at COH so just ignore the verbiage from their site about managed care plans.

I do admire your unmatched ability to cherry-pick words to support your confirmation bias and gloss over any that don't. It's a bit manic but rock on. Not my circus, not my monkeys.

 

[Bevo]

It's the future of all healthcare in the United States. Give it time.

I merely said "changes".