I’VE SPENT SEVERAL DAYS staring at Medicare Advantage providers.
I THOUGHT I found a provider that met the basic requirements: PCP-check
Specialists-check
Hospital-check.
I checked and double checked the information.
But just to be sure . . .
THIS MORNING THE SPOUSE and I drove into another county to sit with a Florida Blue representative. We had an appointment, but the clerks were not ready for us.
- Off to a bad start.
I explained that I had checked and rechecked my information early on the day of the appointment. All the doctors and the hospital checked out for both Florida Blue’s Premier and Classic Advantage plans.
We gave the clerk our list of things to confirm. The list started with the doctors and hospital and went on from there.
- Absence of the doctors and hospital from the Florida Blue Provider’s List is a show stopper.
The clerk started down the provided list.
NONE of the doctors the Florida Blue web site repeatedly showed me as available on the Premier and Classic plans showed up for on the clerk’s computer.
Not one.
They DID appear for OTHER Florida Blue plans, the “extra cost” PPO plans.
“Well, the site is updated overnight,” the clerk told us.
OK, but I checked less than an hour ago, at 10 a.m. I replied. No overnight update here.
On line, all indications are that the practitioners found on the Provider’s List – accessed from the specific plan’s page – are for that plan. There is NO indication on the provider’s list that the provider is available only on a plan other than the plan which accessed the list.
BOTTOM LINE: NEVER trust a vendor’s web site.
I fail to see how lying to potential customers can benefit anyone; not Florida Blue nor the prospective client.
As soon as mid-October rolls around the “victim” of Florida Blue’s web site will have an opportunity to select another provider.
Florida Blue is not the only web site of which to be wary.
Other sites tell me that many of the doctors we want are on their list.
HOWEVER, some of these sites are capitated. See Medicare plans: Beware the plan is not “capitated” (http://tinyurl.com/ycmmlw42)
True, Doctor A IS on the plan’s provider list, but PCP B cannot refer a patient to Doctor A since Doctor A is not on the PCP’s abbreviated (capitated) list.
It is a pain in the posterior – that is not covered by any plan – but prospective clients need to beard the lion and visit the insurer’s physical site as my Spouse and I did this morning. Alternatively, have a representative make a house call. (Florida Blue does NOT offer this convenience; AvMed does and an AvMed representative is scheduled to visit. Will AvMed have the providers we need; its Provider’s List claims it has almost all the doctors. (Sadly, the list lacks an excellent PCP. Maybe it and the PCP’s practice will get back together for 2019.)
I am certain our experience with Florida Blue, AvMed, and Aetna’s Coventry – the capitated plan -- are not unique to the companies or to the geographic area.
- How can you know if your PCP can refer to Doctor A? Ask the PCP’s referral person. The referral clerk is the only person guaranteed to know; the PCP probably has no clue – that’s why there is a referral person.
We almost signed up with Florida Blue because the web site showed us it has the doctors and hospitals we need. Had we signed up, in November the plan could have been unceremoniously dumped in favor of a more honest plan.
No matter what a vendor's web site claims – and this applies to ANY vendor – confirm your understanding with a person who has the authority to “put it in writing.”
Thanks to Florida Blue, lesson learned.
It will be interesting to see if Florida Blue does anything with its web site to correct the mis-information – assuming the clerk with whom we spoke this morning escalates the problem.
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.
Truth is an absolute defense to defamation. Defamation is a false statement of fact. If the statement was accurate, then by definition it wasn’t defamatory.
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