I am a geezer (and proud of it). My Spouse is not (she was a child bride).
We both have United Healthcare coverage; mine is a Medicare Advantage plan.
Back when I was young my employer had AvMed for the troops. It was a pretty good insurance so when it came to selecting Medicare coverage I signed up with AvMed Advantage Medicare.
I stayed with AvMed for several years. I had an excellent diagnostician as my PCP — I credit him and a vascular surgeon for keeping me alive — but one day I was notified that AvMed had dropped my PCP’s practice. Turns out AvMed does that a lot. Patients are not privy to the “why” that AvMed dropped a practitioner, just that the practitioner no longer has a contract with AvMed.
- There are those who might suggest that a PCP who refers too many patients to (expensive-to-the insurer) specialists won’t be invited to sign a new contract with the insurance company. For my part, I suspect AvMed dropped my PCP’s practice due to a totally confused front office.)
In any event, since AvMed quit my PCP, I quit AvMed and signed up with Humana. That was the longest (insurance) year of my life.
Humana PCPs are “capitated.” Basically, that means while the Humana list of specialists is l-o-n-g, the PCP’s list of specialists to whom the PCP can refer is substantially shorter. Over the course of the year I had FOUR different Humana PCPs; of the four, I would recommend only one.
The following year I was back with AvMed. That next year it raised a Tier 2 prescription to Tier 4 — a major increase in my copay. But, there was a Tier 2 alternative that actually worked better for me.
The following year, AvMed AGAIN raised my Tier 2 medication to Tier 4; AvMed’s copay was HIGHER THAN my pharmacy’s retail price — ok, only by 5¢, but . . .
This year I am with one of the many United Health Care (UHC) Medicare plans. I has some benefits AvMed never offered: pretty good dental plan vs. AvMed’s pretty useless dental plan; monthly OTC allowance, and with my particular UHC plan my PCP — the only good one I had with Humana — can refer me to any UHC specialist on the plan’s list . . . but with this plan I don’t need PCP referrals. (I agree with AvMed that patients should coordinate specialist visits with the PCP so that all patient information is centralized.)
What AvMed provided that no other company provided is a contact person. If I had a question or complaint, I could contact that person via email or phone. I almost always got a quick, accurate response.
My Spouse has a “regular” UHC plan through her employer. It seems every year she has a new insurance plan as the employer tries to get the biggest bang for both its, and the employees’. dollars.
She recently broke her ankle.
She was taken by ambulance to the local hospital where an ER doctor aligned the bones and introduced her to a passing orthopedic surgeon. The surgeon planned to set the bones in about 10 days.
- The absolute nightmare of getting the PCP’s office to create a referral is another story for another time. Suffice it to write that my Spouse was playing telephone ping-pong for days.
The surgeon needed authorization from UHC.
Surgery was slated for Thursday. By Wednesday afternoon, UHC still failed to provide the authorization, an authorization the surgeon had requested more than a week earlier.
UHC FINALLY sent an authorization after the surgeon’s normal working hours; it was discovered Thursday morning and my Spouse was told to show up at the hospital Thursday afternoon.
Today she had some pins removed from her ankle and was given:
A prescription for a Cam Boot that will help her with balance until she can put weight on the leg
A prescription for physical therapy.
We took the cam boot script to our local pharmacy and were told that the item is in stock ($80-plus), but that UHC insurance was not honored there,
Back at the house, the Spouse called UHC and after the usual automated answer aggravations she finally talked to someone who gave her the names of several stores within 20 miles of the house. Two of the stores were not interested in doing business with UHC.
“Sometimes businesses drop out and don’t tell us,” a UHC customer rep told the Spouse.
Same thing when she had to call yet another number to get the names or physical therapists. Of six names provided by UHC, two only did PT with children and a third didn’t accept UHC, Several calls later the Spouse found a location that was actually close to the house (within 5 miles), that worked with adults, AND that accepted UHC.
Having found everything I ever needed with AvMed at the AvMed Medicare site, avmed.org, I went to www.myuhc.com to see if any PT or medical supply companies were listed on the UHC site.
Unlike AvMed, “myuhc” keeps such information secret. I tried to create an account for the Spouse, but the UHC site prevented completion; if the information was available to registered-online members, I could not get to it.
All in all it took the Spouse — who prefers the phone to the Internet (where the information is not accessible anyway) only about three hours of phone time to finally — to maybe — get the information she needs.
AvMed was hardly a perfect plan, but at least insureds could get to a CSR via email and most information WAS available on the web. If only it didn’t try to charge me a copay higher than the retail price I might have stayed. True, I had to get referrals to see a specialist, but that never was a problem, and all the specialists on the AvMed list were accessible to me.
As it happens, my current PCP works with AvMed and UHC — and Humana and how many others I don’t know. His office isn’t perfect — there apparently is another patient with the same name as this scrivener and a birthday only 5 days prior to mine so the staff needs to be educated to check all the patient information before filing patient data into the folders. (That’s scary.)
There IS much to be said for UHC’s Medicare plan — some good and some not so good. Communication with its insureds is one of those “not so good” items.
PLAGIARISM is the act of appropriating the literary composition of another, or parts or passages of his writings, or the ideas or language of the same, and passing them off as the product of one’s own mind.