I had the pleasure of having to watch a webinar at work today. It was all about the different Medicare Advantage Plans/PPO's and how to bill them and ensure that our hospital is getting paid.
Some of the stuff the presenter said hit a nerve and I thought I would share it here.
We all thought Medicare was doing us a favor by allowing private fee for service insurance companies offer better coverage including pharmacy for the same price as Medicare. Well these plans are "temporary" in the words of the presenter. They are a way to get us away from the government paying our medical bills and shift all insurance to the private sector. As it stands right now, any facility that recieves federal funding CANNOT turn down a Medicare or Medicaid patient based on whether the patient can pay. It is against the law. In other words, if you recieve any government funding then you can not turn down Medicare Medicaid patients. But in the next couple of years (now remember I am watching this as an employee of the hospital), the hospitals will have the option of either accepting these Advantage plans or not because they technically have nothing to do with the government anymore. Some doctors already do not accept some advantage plans. The hospitals will have to bargain with the advantage plans just like they do now with the likes of BcBS and other popular insurance. Contracts are negotiated and payment rates are predetermined by negotiation of a contract for BCBS at our hospital.
That means if the hospital does not accept your insurance, they dont have to treat you as a patient and can literally turn you away. Now emergency situations and ERs will be different as no one can be turned away after triage with a life threatening situation.
But all these urine tests and x rays we have to have will be at the mercy of your local hospital and whether they choose to take your advantage plan or not. Right now most hospitals just accept advantage plans because they are new.
I have had several doctors offices turn me down for appointments because they dont want to navigate the red tape. Advantage plans still follow the same coverage rules as Medicare and if your test isnt covered by Medicare then your advantage plan dont pay it. The only thing saving us right now is that Medicare requires advanced beneficiary notice from the hospital when a test isnt covered. In order to make you pay the amount that is not covered by Medicae, the hospital is required to have you sign a form and they must tell you that you are responsible for payment before you have the services. The Advantage plans have not figured this out yet so the hospital just eats the cost of the non covered tests.
I just worry about keeping my insurance. Private insurance does not provide the coverage that I get from my Humana Advantage plan. My AFO's are a fine example of that....BCBS wouldnt pay a dime of the $1,000 when I had it. I paid roughly $250.00 copay with my advantage plan.
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