Trying to salvage a controversial experiment to confront rising drug costs, the Obama administration Tuesday hinted at modifications to an ambitious plan that would revamp Medicare payments.
Source: Medicare weighs changes to controversial plan on cancer meds | Lexington Herald-Leader
Inevitably each year there are a number of problems that come up with clients where they receive bills they were not expecting. Nearly 100% the time the problem can be traced back to the same problem; the client screwed up. That’s the only way I know to say it. Nearly every time they went somewhere, received some service or treatment, and never gave any thought to if the procedure or treatment was covered, or if the person performing the procedure or treatment was “in-network” or not. Folks, whether you are in an HMO or a PPO or an RPPO, it’s ALWAYS important to talk to your insurance company about ANY procedure or treatment you need done. It’s also important that you whip out those insurance cards every time you see your doctor or service provider. AND, be sure that you ask new doctors or providers the right questions. Do NOT ask them, if they “take ________ insurance”. They will always be happy to take your insurance card, and file the claim it seems. They do not necessarily care though if the company pays the claim or not. If they do not collect the money from the insurance company, they know they can later bill you for it. You were the one that received the treatment or service. Right? What you want to ask them always is if they are “”in network” for ______ insurance.” That’s the question to ask. And, make sure that your doctors are using “in network” options on all your tests, labs, etc.
I have had a difficult case this year where the client did most everything right, but STILL ended up receiving bills he was responsible for. He visits the doctor about every 90 days for blood work. He did the right thing by asking the doctor to use Labcorp for his blood draws, and the doctor even wrote that on his referral. It says it really clear… “Labcorp” and then has their provider number right there on the referral. A couple of months after he had the blood draw he received a bill for like $95. After 20 hours of research on my part I think I figured out what happened. The doctor intended for Labcorp to do the blood draw… and they did, BUT, the analysis work that was done on the blood ended up being done as a hospital service by the hospital that is over this doctor’s practice. And because the blood was analyzed by the hospitals people, it was due a $95 copay. The client did everything right I feel. He told the doctor he needed Labcorp to do the blood work. And they did. But, I think either the doctor or the hospital messed up when they did the work. Either the doctor only indicated that the blood was to be drawn by Labcorp and no instructions on where to process it, or the hospital just billed incorrectly. Either way, it was a mess. And, still to this moment, my client is stuck with this bill. I am telling you now guys; always, always, always be specific about the services and treatments and providers you are using. If you are not, you will get bills from time to time, and if you are like me, you just HATE these sorts of surprises. Call the numbers on the back of your cards and verify where and how to get all your procedures and services and treatments performed BEFORE you receive them. That is the best advice I can ever offer.
Source: Sanders-Brown Center on Aging | Sanders-Brown Center on Aging
5th Annual MARKESBERY SYMPOSIUM ON AGING AND DEMENTIA
Community Session
Saturday, November 21, 2015
8:30 am – 12 noon
Lexington Convention Center
Bluegrass Room
430 W Vine
Lexington, KY 40507
The University of Kentucky Sanders-Brown Center on Aging presents the 5th Annual Markesbery Symposium on Aging and Dementia (flyer attached). The public is invited to attend this free informational program on Alzheimer’s disease to be held on Sat, Nov 21, 2015 at the Lexington Convention Center. The symposium will kick off at 8:30 AM with check-in and continental breakfast. Dr. Ronald Petersen of Mayo Clinic, who treated former President Ronald Reagan and singer/songwriter Glenn Campbell, will be the keynote speaker. The program will also include several presentations designed to highlight research and promote normal, healthy brain aging, and conclude with a question and answer session on memory and brain health issues.
The events are free and open to the public; however, you must register to attend. For more information or to register visit www.centeronaging.uky.edu, phone 859.323.6040 or email [email protected]. Complimentary parking will be available in the High Street parking lot.
August 20, 2015
We at Anthem Blue Cross and Blue Shield (Anthem) are committed to providing our members with access and choice for their medical care. One way we do this is by contracting with hospitals and physicians to participate in our provider networks. We have been in negotiations with St. Elizabeth Healthcare in Northern Kentucky, and they have decided to end their participation in our Medicare Select network effective January 1, 2016.
There will no longer be Medicare Select facilities in the Kentucky counties of Boone, Campbell, Grant and Kenton. St. Elizabeth Healthcare has been a part of the extensive network for over 15 years, and we are clearly disappointed that they have made this decision. We will continue to talk with St. Elizabeth Healthcare in hopes of reaching an agreement.
St. Elizabeth Healthcare operates six facilities in Covington and other parts of Northern Kentucky:
| St. Elizabeth Covington 1500 James Simpson Jr Way Covington KY 41011St. Elizabeth Edgewood 1 Medical Village Dr. Edgewood, KY 41017 St. Elizabeth Falmouth |
St. Elizabeth Florence 4900 Houston Road Florence, KY 41042St. Elizabeth Ft. Thomas 85 N. Grand Ave. Fort Thomas, KY 41075 St. Elizabeth Grant |
We will be notifying our members by letter the first of September, which will include several options regarding their health coverage. We will also include in the mailing a listing of other Medicare Select plan facilities in KY and OH.
The health coverage options listed in the letter for the member are:
Anthem has participating facilities in the Metropolitan Cincinnati area that your clients might consider using for elective inpatient admissions. Emergency admissions do not require network use for maximum benefits. See the links above for those providers in close proximity to the Metropolitan Cincinnati area.
At Anthem, we’re committed to helping you succeed. We know you are a huge part of our strength and success, and we value your trust and partnership.
Source: Bluegrass ADD – Pathways Resource Guide 2014 – 2015
A wonderful guide for seniors. Providers, services, ideas… all in there to assist.
With zero doubt, we all want to be smart consumers and on the subject of Medicare, as a beneficiary, you have to know the facts each year to make sure you are saving the most amount of money possible on your healthcare costs. By knowing the facts, you can avoid some “surprises” when you need healthcare; namely unexpected costs.
Every year Medicare health plans change. Their premiums, deductibles, copays, coinsurance; all these things can change… your COSTS can change. Each year providers, facilities, and drugs enter and exit plans. Each year plans themselves enter and exit the marketplace.
Even covered procedures.
Call a professional; a licensed, experienced healthcare insurance agent or broker, and have them sit down with you and explain your options. A “broker” is the best possible option because they frequently represent multiple companies, rather than just a couple or even one. Brokers can remain unbiased and uninfluenced by individual plans because they remain independent. Sales agents working for one plan and want you to buy their plan. Right? An agent is not going to be paid if you choose their competition. Makes sense, right?
What you need is an unbiased professional that you can trust to sit down with you and help you double check your plans against all those being offered to make sure.
While they are there, you should have them verify your physicians and other providers status; that they are “in-network” for the plan you choose. Not that they accept the plan… because that can be misleading. They need to be “in-network” for your plan. This is especially important in HMOs. Providers are very often moving in and out of network for plans.
They need to also check your facilities. Your hospitals, clinics, practices to make sure they are “in-network” as well. You really do not want to pay “out-of-network” rates if you do not have to. See the chart below.
Checklist for how to save time and money. Make sure your adviser does these things when you meet with them.
Heavens no.
Any agent; independent or not may be able to enroll you in a healthcare plan of your choosing if they are appointed and have certified with that plan on their product offerings. We do not even need your prescription list, provider list, etc. In fact, most agents don’t want to spend the time necessary to do all this research when they come to see you.
And, it’s important for you to know that, if you share that information with them, that it has NO IMPACT ON WHETHER YOU CAN ENROLL OR NOT… During the Annual Enrollment Period (AEP), you cannot be turned down due to poor health conditions. Everyone is accepted. The only purpose for sharing that information with your agent is so that he can evaluate what your possible healthcare costs will be for the coming year. It has nothing to do with ability to enroll.
The fact is our lives would be easier if we did not do all this research. Can you imagine. If I had 1000 clients for instance? Do I really want to look up maybe 10,000 drugs if each had 10?
No. This is not for us. Rather, this research should be our commitment to you. This is what I do for you that most will not. I want you to know all your facts so that you can make an informed educated decision, so that next year, you are not caught with a financial surprise!
If you would like my help, then contact me. You can email me at [email protected] or call me at 859.654.0120
To visit my “Contact the NINJA!” page, go HERE!
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Well, I am pleased to report that I have just completed all my annual re-certification exams for this upcoming AEP (Annual Enrollment Period) season.
I am ready to serve my Medicare clients this fall. This year I will be representing at the very least; Humana, Anthem Blue Cross/Blue Shield, Cigna, and Silverscripts (new for me). I will also be adding either Aetna or Medico or both.
For ACA, I will be representing Humana and Anthem Blue Cross/Blue Shield.
I choose these companies because I believe them to be the best of the lot; experienced, great product offerings, at good prices.
This year, as in past years, I will first turn my attention towards my valued clients. I plan to see all of you needing to be seen from October 1-14; prior to open enrollment season. I want to get you taken care of first. You are my top priority. With a little bit of lunch, I can have either a telephone call or face-2-face with all of you during time frame.
IMPORTANT: Be sure to send back your 2015 Medicare.gov form completed no later than September 1st.
2015 Client Update Form <<<Download, print, fill out, and mail back to me at;
Michael Todd Oldfield
3408 Crimson King Court
Lexington, KY 40517
I will be scheduling appointments in the order in which i receive the forms back. Get yours back today!!!!!
