Medicare Question..

[rpowell01]

I have medicare and originally I switched to Humana Medicare Advantage to take advantage to the lower co payments and out of pocket costs. But, the one thing I dislike very much is I have been waiting approximately TWO months to get approval to have shots done in the joints of my lumbar spine.

I did originally get approved in December but the pain management doctor was so booked he couldn't schedule the shot until after the new year. But Humana only approved the shots to be done by the end of December. A few minutes ago I called the Doctors office and they told me they did resend to get approval and so I have been waiting and waiting. Tired of waiting..

My question is has anybody had Humana Medicare and dropped it and went back to straight medicare? Its my understanding that with regular medical you don't have to get approved.

Thanks for the answer because I am about to drop Humana in the next week.

[georgiapapa]

You do not have to be pre approved to see a specialist with original medicare.

[jbasser]

Humana treats everything like a HMO. Drop them like a bad habit and pick up an anthem plan.

J

[Chuck75]

I have medicare and originally I switched to Humana Medicare Advantage to take advantage to the lower co payments and out of pocket costs. But, the one thing I dislike very much is I have been waiting approximately TWO months to get approval to have shots done in the joints of my lumbar spine.

I did originally get approved in December but the pain management doctor was so booked he couldn't schedule the shot until after the new year. But Humana only approved the shots to be done by the end of December. A few minutes ago I called the Doctors office and they told me they did resend to get approval and so I have been waiting and waiting. Tired of waiting..

My question is has anybody had Humana Medicare and dropped it and went back to straight medicare? Its my understanding that with regular medical you don't have to get approved.

Thanks for the answer because I am about to drop Humana in the next week.

What you are experiencing is the difference between "PPO" and "HMO" plans. PPO is closer to standard Medicare for approval practices.

[rpowell01]

I dropped Humana Medicare effective January 31st. and the plan I had was a medicare PPO but everything had to get preapproved. I called them and they said I needed to send them a letter. So I wrote on the letter why I am dropping them because with regular medicare patients don't need preapproval but their plan does. I told them that I find it unfair and unprofessional that patients have to wait that long for preapproval.

IMO if medicare is going to allow corporation like Humana to supply insurance to medicare patients then I think corporations like Humana MUST follow the same exact rules as regular medicare.

[georgiapapa]

rpowell01,

I may have been given incorrect info by a lady at the SSA office but I was told that all medicare advantage plans, regardless of whether they were PPO or HMO, required prior approval to see specialists. She informed me that original medicare did not require prior approval. I have original/regular medicare as my primary insurance and BCBS as a retired federal employee. I have never been required to get prior approval to see a specialist. My doctors do get prior approval when I require inpatient hospitalization.

Good luck to you.

[Chuck75]

I dropped Humana Medicare effective January 31st. and the plan I had was a medicare PPO but everything had to get preapproved. I called them and they said I needed to send them a letter. So I wrote on the letter why I am dropping them because with regular medicare patients don't need preapproval but their plan does. I told them that I find it unfair and unprofessional that patients have to wait that long for preapproval.

IMO if medicare is going to allow corporation like Humana to supply insurance to medicare patients then I think corporations like Humana MUST follow the same exact rules as regular medicare.

The Medicare Advantage companies get paid by both medicare and the insured. Obviously, they are in business to make money.

That said, Medicare standards, payment, practices, etc. should be the minimum, not medicare advantage plans.

As one having had my employer's sponsored health plan convert to Medicare Advantage, (or pay an outrageous premium (~ 2K a month),

I'm quite sensitive to problems related to Medicare Advantage. A recent disappointment has to do with a forced change in Medicare Advantage providers.

The "New" provider for 2015 is actually an "old" provider, and my wife had problems with getting approval for diagnostic tests (MRI).

I believe (but cannot prove) that the refusal resulted in treatment delay, additional pain and less effective treatment.

I'd also sat that the government (again) is takang advantage of disabled veterans in this, because medicare coverage is required in many cases,

even when the treatment is due for service connected conditions. When this is the case, I believe that the veteran's expenses (premiums, out of pocket, co-pay, etc.)

should be paid by the VA. Instead, recently, there was talk of having medicare pay the VA! The "Veteran's Choice" program, so far, is another example of

a highly touted "solution" that, by any reasonable measure, does not live up to the "hooplah"!