Out of network provider wants to now bill me????
- Thread starter vic120
- Start date
For me it’s been 100% when I look up dr’s . I can’t speak for anyone else .
That is not proof.
Your carney show may play well with your customers but don't come around here peddling your hype.
Where do you get your info? From CNN?
Maybe the problem is your inability to recall facts and produce supporting documentation.
THIS is an example of proof . . .
One percent of all non-pediatric physicians have formally opted-out of the Medicare program in 2020, with the share varying by specialty, and highest for psychiatrists (7.2%).
Psychiatrists account for the largest share (42%) of all non-pediatric physicians who have opted out of Medicare in 2020.
In all states except for 3 [Alaska, Colorado, Wyoming], less than 2% of physicians in each state have opted-out of the Medicare program.
https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/
And this . . .
In 2017, the American Academy of Family Physicians surveyed members about their participation in the Medicare program, and 83% of physicians reported that they accept new Medicare patients.
Today, most doctors do accept Medicare patients, and there are many ways to check if a healthcare provider is participating.
Do most doctors accept Medicare? Assignment, rules, costs and more
Ninety-three percent of non-pediatric primary care physicians say they accept Medicare
Do All Doctors Accept Medicare? | Healthline.com
Your magic bean plans have 100% participation, which is more than participate in Medicare.
Again, I call BS on your 100% sales pitch that is out of touch with reality.
I recently talked to 2 ladies in Macon that have a Medicare PPO plan. When they turned 65 they had to look for new docs . . . their current PCP was not taking Medicare PPO plans, even existing patients.
It took them several weeks to find a new PCP that would take them, and their plan,
A quick search found 166 PCP's in Macon accepting new Medicare patients. Unfortunately for both of them, their only choice is to keep what they have or look for a new MA plan. Of course, that will NOT expand PCP options.
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First you said 99% of docs participate, now it is 100%. Why not 110%?
So which is it?
What day is it in your world? Who is the president?
Do you know Tommy Flanagan?
- Thread starter
- #16
Yea that was it we saw the claim there in the portal my wife keeps track but we had not got the bills,
We have high deductible HSA we have HSA Card with money on it to pay deductible
But we had not got any bills sent to us
So my wife has been trying to contact them for months 4 months at minimum, They only got back to us with voice message the other day
I have to ask her but seems like nothing seemed odd in portal other then the fact that we had not got a bill in the mail
he fact that we had not got bill in the mail is what caused us to call and email and call and call again
Then to call ins company who confirmed they are out of network
and again I still have not received a bill so I dot even know what that means they certainly are not trying hard to get paid, at least not yet
The claim was adjudicated and denied. What is the adjudication/denial date? You mentioned earlier that your doctors were notified of your new medical plan, does this include the DME provider?
- Thread starter
- #18
Just got updated new cards I need to see what was in the portal My wife has been looking at it notheg she saw made her thing anything was wrong when looking at claims would not say paid because it goes to deductible normally
She didn't see anything that made her think it was denied we only c]found out when she contacted them, after we got word from DME on voice mail she did IM with carrier and that's where she got confirmation claim was denied due to out of network
but she said there is no indication of that in portal Ill have to look at it myself later
@vic120 do you have a PPO Select plan? I believe you said something before about the network being more strict than a regular PPO.
This is just a guess. PPO Select can occur in the Medicare market, but I don't know if they are offered in the ACA market.
This is just a guess. PPO Select can occur in the Medicare market, but I don't know if they are offered in the ACA market.
- Thread starter
- #20
No I really wish I could remember what they said PPO stands for but they say its HMO and PPO on card does not mean preferred provider Organization
In fairness I did not buy it thinking it was a PPO just saw it on the card afterwards
Only problem Is I thought I bought the same plan and network as last year everything was identical, But alas BC added a new HSA in addition to the one I get every year identical in every way except Much lesser network
It has been a headache all year
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