Sneak Peaks and Rumors

cataract surgery is billed as an outpatient procedure on most advantage plans. It most certainly is covered.
Your customers are either on an hmo and the provider is out of network OR the provider is billing incorrectly.
Get involved with the bills with your consumers and come out the hero with correct answers.
 
Ok the guy was wrong about cataract surgery

Enough people corrected him

he has not disputed

do we really need to keep going on and on about cataract surgery?
 
pay $200 PLUS $35 a month (for PDP)

What are you writing with those premiums?

Most of my clients buy G and rarely pay over $120 unless they are old. Same on the Rx. The Humana $12 plan for most but I have a few that need the $30 plans from Wellcare, etc.

As for the cataract thingy, I won't bust your chops on that one but there is a clarification.

Medicare (original or MA) does cover cataract surgery as others have indicated but it only pays for the "basic" lens. You need reading glasses.

If you want to upgrade to the super lens and do without the reading glasses you have to pay extra regardless of which plan you have.

most people needing cataract surgery are covered at least in part by some kind of health insurance such as Medicare for those aspects of the procedure that are considered medically necessary.

For example, implanting a standard monofocal IOL during cataract surgery would be considered the standard of care and medically necessary. This is because your eye's natural lens is removed as part of a cataract procedure, and you need an artificial lens as a replacement to restore your sight.

You likely would have very good distance vision with this type of IOL, but usually you would need reading glasses for near vision.
What Does Cataract Surgery Cost?


And from Medicare.
http://www.cms.gov/outreach-and-edu...nloads/visionservices_factsheet_icn907165.pdf
 
Allow me to clarify.

It will not be covered at 100%, as with a Medicare Supplement Plan. More importantly, at least to my clients, usually their eye doc is not in network.

There are times that I don't type everything I am thinking.

I do appreciate all the comments as to my knowledge (or lack thereof). It was deserved, based on what I typed.

DVH here in Atlanta sucks.
 
Some of the carriers have let agents have a peak of the benefits highlights that have been filed with CMS but not yet received final approval by CMS .My understanding is that it's rare that the benefit highlights revealed in the sneak peak are not approved.

Was this info on BCBS supposedly from an agent/fmo that got a sneak peak or complete speculation? I have talked with someone who supposedly know someone who got a sneak peak on the UHC RPPO and they are supposedly maintaining 0 premium and pretty much the same co pays .Will see

Anybody hear anything about Humana's RPPO in Fl. or Florida Blue's RPPO premium co pays?


Entertainment at last FB meeting:

 
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Ok the guy was wrong about cataract surgery

Enough people corrected him

he has not disputed

do we really need to keep going on and on about cataract surgery?

Vic he has not responded either so back up. Just making sure he sees it.
 
Vic he has not responded either so back up. Just making sure he sees it.

This is me responding.

In all 4 cases in the past two years, the eye surgeon that my clients wanted to use was not in network. Since all 4 happened to be on HMO MA Plans, then my narrow view was that MA will not cover, ESPECIALLY if the eye surgeon is not in network.

Funny thing about old people, they don't like using doctors they don't know.


But, please feel free to continue to inform me of my ignorance, and you can even, if you are so inclined, ask me how in the WORLD I got my license. I can take it. I'm a big boy.

Someone show me how an HMO MAPD will cover cataract surgery if the surgeon is out of network. vs. Using a Med Supp.

Just for laughs and giggles, the four MAPD Plans were Humana and CIGNA, in case anyone wanted to know.

I still can't believe that, out of my original rant, THIS is what everyone picked up on and ran with. I assume you agree with me on my other points!?
 
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Vic he has not responded either so back up. Just making sure he sees it.

All I'm saying is the point is made

does this thread need to be totally derailed for this

or do you just have a need to keep sticking it to him
 
Someone show me how an HMO MAPD will cover cataract surgery if the surgeon is out of network. vs. Using a Med Supp.
By that rationale no need to single out cataract surgery. An HMO MA typically doesn't cover anything out of network except urgently needed care.
 
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