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V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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Medicare Advantage plans are different than plain Medicare in that Advantage plans include a private insurance segment while Medicare is completely federal. The plain Medicare supplements must provide certain things to be considered viable for that Medicare plan. I’d be wary of any type of pressure to sign up for a particular plan. I'm not a Medicare expert but my guess would be that Advantage plans - like any private plans - may have more leeway in deciding who they cover. Plain Medicare (Plan F is the most expensive supplement but great since there are no co-pays) will supplement whatever Medicare covers as long as the facility takes Medicare. Advantage plans generally cover more things such as vision and sometimes dental but there are copays and you are dealing with a private insurer with more clout in the final page than with straight Medicare so you need to choose carefully. As was mentioned, doctors may have to sign up for providing care for each plan. I'm not sure how that works. All of the Medicare and Medicare Advantage choices can be complicated so making these choices is easier with someone who knows your state and federal laws as well as all of the possible plans. The problem is finding someone who can help but doesn't have something to gain by steering you toward a certain plan. There were some excellent answers here. As always, I learned just from reading. Thanks to this wonderful group of people. Carol
The health care industry is organized by insurance companies. For physicians to be able to receive any payment from an HMO/PPO or medical advantage insurance company they must be a member of that plan. Insurance plans limit which doctors can be a member, mostly to control cost. So when your doctor says that you must be a member of a certain plan - it is probably because she or he is not an authorized physician. Of course, a person can pay a physician directly - but that would be costly. It is important every open period for medicare to assure that your providers continue to be a member of the plan. If keeping your physician is important than you will need to change your plan. Of course there may be a trade-off on cost and benefits. There are agencies that can help you do this analysis.
Ms. Randall is right. It's not just Medicare. I wanted to keep my PCP but she didn't accept the insurance I had. I didn't see her for a year.. The following year, I went to her website and made sure she accepted the plan before I signed up,for it. There was no real forcing or demanding, it's just the way it is. If you want to continue seeing a certain doctor, you need to sign up for a plan they accept or change doctors.
Health care in the US is basically a closed system with access available to the consumer AND also the providers as per whatever insurance payor they have.
Reg - for you what probably as happened is that the Village has entered a negotiated payment agreement with United as a member or preferred provider. So the doctors, therapist, hospitals, etc. at village are all affiliated providers with united and have accepted to be paid at whatever rate United has set to be market rates for your area.
Your doc may do private pay alongside being with United.....it will be quite a bit of $ if your just used to only doing a copay. But please keep in mind that even if you do private pay say for your internist, if your internist writes orders for tests or that you need a consult with a cardiologist....that the lab & cardiologist have too entered an agreement with United. Thats why its considered a "closed" system. So your private pay costs could be huge and you may have to pay up front before you even see the MD.
If your very rural or small town / city, the options for care will be very very limited. So may need to travel to a big city where there is a health science center affliated with a medical school to find providers who take all the various insurance payors and have benefits staff who know how to bill & code for each insurance carrier.
The only solution imho is universal single payor health insurance......which seems to be beyond the current political will to ever happen in the US. Think carefully when you vote in November as to whomever you are voting for would be supportive of universal health care system.
Reg, you probably signed some acknowledgements and other forms when you signed up with Village Health. And probably buried somewhere in size 2 font in those contracts are the rights to restrict your medical providers.
Medicare Advantage Plans are different from Medicare in that they have Net-works. Some Doctors refuse to join a Net-work but will join others. I'm not sure for the reasons, But with that kind of attitude you may want to find another doctor
Again, Ms Randall, you're right. That's why I didn't see my doctor for a year. It all boils down to finances. If money is no object and Reg can continue on with the physicians they have on board, that's wonderful. However, in my case, I could never afford the out-of-pocket costs to keep my doctor. As it is, my lousy insurance coverage and high deductible that I have now still preclude me from visiting specialists and having surgery that would make my life easier and less painful. Sometimes it's just a lose-lose situation.
MsRandall: My Medicare and Medicare Supplemental was set up pro bono by an insurance agent who came to the house a few years back. He reviewed which doctors I saw and I signed up for Medicare Supplemental Plan F. In this case, the OP resides in an active retirement community, which may have some bearing on it. The only time I have ever had to ask a doctor "do you accept Medicare patients?" is to by GYN and that was a yes.
Igloo: I agree on your comment that The Villages active retirement community has already established what their residents' Medicare Supplemental Plan will be.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
The plain Medicare supplements must provide certain things to be considered viable for that Medicare plan. I’d be wary of any type of pressure to sign up for a particular plan.
I'm not a Medicare expert but my guess would be that Advantage plans - like any private plans - may have more leeway in deciding who they cover. Plain Medicare (Plan F is the most expensive supplement but great since there are no co-pays) will supplement whatever Medicare covers as long as the facility takes Medicare.
Advantage plans generally cover more things such as vision and sometimes dental but there are copays and you are dealing with a private insurer with more clout in the final page than with straight Medicare so you need to choose carefully. As was mentioned, doctors may have to sign up for providing care for each plan. I'm not sure how that works.
All of the Medicare and Medicare Advantage choices can be complicated so making these choices is easier with someone who knows your state and federal laws as well as all of the possible plans. The problem is finding someone who can help but doesn't have something to gain by steering you toward a certain plan.
There were some excellent answers here. As always, I learned just from reading.
Thanks to this wonderful group of people.
Carol
Reg - for you what probably as happened is that the Village has entered a negotiated payment agreement with United as a member or preferred provider. So the doctors, therapist, hospitals, etc. at village are all affiliated providers with united and have accepted to be paid at whatever rate United has set to be market rates for your area.
Your doc may do private pay alongside being with United.....it will be quite a bit of $ if your just used to only doing a copay. But please keep in mind that even if you do private pay say for your internist, if your internist writes orders for tests or that you need a consult with a cardiologist....that the lab & cardiologist have too entered an agreement with United. Thats why its considered a "closed" system. So your private pay costs could be huge and you may have to pay up front before you even see the MD.
If your very rural or small town / city, the options for care will be very very limited. So may need to travel to a big city where there is a health science center affliated with a medical school to find providers who take all the various insurance payors and have benefits staff who know how to bill & code for each insurance carrier.
The only solution imho is universal single payor health insurance......which seems to be beyond the current political will to ever happen in the US. Think carefully when you vote in November as to whomever you are voting for would be supportive of universal health care system.
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