Over a 5 year period I had one minor issue with United. I called Medicare, they called United, and the next day it was resolved.
There are a number of companies getting into te market and ther are problems I have heard about with them. No different than my expeince with private insurance.
Dealing with private HMOs cam be like pulling teeth. There are private companies who are known to intentional deny covered treatments making people jump trough hoops hoping they give up.
You realize MA plans are HMOs? Around here the main players are Humana and United. Humana is generally rated not quite as bad.
We've had multiple cases of multi-month waits and one bogus denial it took 6 months to get somebody with some sense to look at and fix. (The idiots authorized a STAT referral starting
tomorrow--then denied the claim when the procedure was done a few minutes later because it was outside the authorization dates. The system was set up so we had no way of communicating with the people responsible for that stupidity and ended up having to go over their heads.)
You get the low copays, you get things like Silver Sneakers--but you get delayed care.
Around here I think it was United that got hit with a big lawsuit because they paid attention to price and let a doctor back into their network that they had kicked out for quality reasons. Last I knew 7 deaths had been directly attributed to his unsanitary cost-cutting, lots of other Hepatitis C infections and who knows how many missed cancers.
My plan is a PPO. I would never have considered an Advantage Plan if I had to take an HMO, as HMOs only allow you to use doctors that are in network. I can use any doctor who takes M/care for a slightly higher copay. I guess I'm lucky to live in an area where I've never had to wait more than a week or two to get an appointment with a provider of my choice. Just about every doctor in my area takes Medicare, but we do have a lot of older adults here and that may be the only way they can get enough patients. I know there are some doctors in Atlanta who don't take M'care because my former employer was bitching about that. She was on Medicare herself.
It's true that APs deny services more often than other insurance plans, but most of the time, the patient wins if they appeal the denial. Most people probably don't realize that. Again, it's all about greed.
I have began to wonder if my own doctor is trying to upcode me. She is always, imo, over reacting to slightly abnormal lab tests. For example, my liver enzymes have been mildly elevated for about 20 years. My former doctor, now retired, told me that they would have to be about 4 times higher before it would be of concern. Both of them checked me for Hep C, since that is the only known disease that can cause mildly elevated liver enzymes. Maybe she's just being overly cautious, but she ordered a liver ultrasound last year, which of course was normal. I like her but I do find this very annoying and I hate unnecessary tests being ordered, as they increase the burden on M'care. That is a huge problem when it comes to M'care, especially if the provider has the equipment to do the procedures in their own practice.
I would have to be close to death before I agreed to be hospitalized, and reading about these so called non profit hospitals has just made my hatred of hospital worse. I'm having knee surgery next month, and my surprisingly kind, reasonable surgeon agreed to do it out patient. That helped me make the decision to have it done, after putting it off for years. The hospital he uses has a lot of bad ratings, so I'm hoping all goes well and I'll be in and out on the same day. Stay out of the hospital if at all possible. There are even some experiments with at home hospitalization. They use monitors and something like zoom to keep in touch with the patient, but at least the patient isn't exposed to all the nasty germs in hospitals. I've sen so many doctors who had poor infection control techniques, including not washing their hands prior to changing a dressing or examining a patient. But, I digress.
And, yes to Steve's comment about Kaiser. If you're on their AP, you have to use their services unless they don't have a specialist available that you need. My former patient lived about 30 miles from the only Kaiser center in our area. While Kaiser often provides decent care, I like my providers to be very close to where I live, and I like to have choices. All of the doctors I've used in the last few years have been within a 10 minute drive from my home.
It's greed and profit that are a huge problem for America's healthcare system. It wasn't that way when I entered the nursing profession in the mid 70s, but it's changed drastically since those days.
