For those who went to the Cleveland Clinic… did they do this to you?

[kentuckyed]

The Medigap underwriting policy for pre-existing conditions makes it virtually impossible for most people to return to a Medigap policy after going to a Medicare Advantage policy. Many people are hoodwinked by the various has-been celebrities hawking these unscrupulous Medicare Advantage policies. Medicare Advantage will accept anyone and then just deny coverage as they see fit.

 

[Superman]

What I really want to know is why these Medicare scammers are calling me five times a day from different numbers. I won’t be eligible for 15 years anyway. And every time I navigate their robots and get to a live person, they hang up on me before I can finish telling them they’re wasting their time, remove my number from the computer!

I block and delete every number they call from and they never run out. I am on the National Do Not Call registry.

 

[johninsd]

What I really want to know is why these Medicare scammers are calling me five times a day from different numbers. I won’t be eligible for 15 years anyway. And every time I navigate their robots and get to a live person, they hang up on me before I can finish telling them they’re wasting their time, remove my number from the computer!

I block and delete every number they call from and they never run out. I am on the National Do Not Call registry.

I use the "Do not disturb" setting on my phone so it won't even ring unless the incoming call is from a number in my contacts list. Calls from other numbers are sent to voicemail so if it is a call from other than a scammer they can leave me a voicemail - the scammers rarely do - I was surprised to receive a voicemail from a scammer a few months ago - said I should call him back about "really good news" - I never called of course. I think most phones have this capability.

 

[kentuckyed]

What I really want to know is why these Medicare scammers are calling me five times a day from different numbers. I won’t be eligible for 15 years anyway. And every time I navigate their robots and get to a live person, they hang up on me before I can finish telling them they’re wasting their time, remove my number from the computer!

I block and delete every number they call from and they never run out. I am on the National Do Not Call registry.

Just Lucky I guess.

 

[dick0236]

May I ask what company your MC Advantage plan is with?

I also have a Humana Advantage plan.......that is "plan specific" to Jefferson County Ky and suits
my needs very well.

I recently received my 2024 copy of "Medicare and you - 2024". It is the official US medicare handbook that outlines
the Medicare services for next year. This handbook also lists the major companies that have contracted with Medicare to offer Advantage plans for 2024. There are 9 insurance companies listed with a total of 86 different plans.

Asking why they are not all the same is like asking why all three-bedroom homes with two baths aren't priced the same. It's "location, location, location" and "bells and whistles". You are a retired real estate agent and you can easily understand why the costs differ.

You have cancelled your appointment at CC so I assume your need for surgery is not urgent. I suggest you work with Humana to find "network" providers for your specific Humana plan.......or change plans during the open enrollment period.

 

[carolinemc]

My Medicare denied my surgery stating the I'm "not very severe" (I guess that means critical) and I do not have congestive heart failure (so I have to incur more heart damage first). Yes I can go back to original Medicare, however you normally can not get a supplement plan unless you signed up for one in the first 6 months of starting Medicare. I don't know if there are exceptions to this, I need to research that.

As far as going back to the CC... NO! The CC may have great surgeons but their business practices are unlawful and unethical from what I experienced, and their $450k - $500K fees are outrageous. There was a class action lawsuit filled against the CC in 2020/2021 regarding their business practices and the court ruled against them on every point. The CC's website and promo materials are in line with the court but they have not upheld those standards in practice was my experience.

When they couldn't keep their stories straight on the financial issues, speaking out of both side of their mouth, it became clear I'd be dealing with them for many years ahead if I proceeded. They wouldn't file a simple appeal on the front end but they're going to go battle on the insurance denial after the surgery?
I was supposed to fly out today. When the surgeon's nurse practitioner called yesterday to confirm that I was not coming, I was surprised she made a point to tell me things were not her fault.

I would never feel good about the advantage plans for Medicare, for many will deny you procedures and medications.

 

[carolinemc]

The answer is, it depends. In a few states, they're not permitted to do underwriting. In the majority of states, one will have to go through underwriting. Everyone must have Medicare parts A & B. that's true for both Advantage and Medigap plans.
The difference is advantage plans are guaranteed issue. They have to take you no questions asked, no restrictions about preexisting conditions.
Medigap plans are allowed to choose whether or not to accept a person.
I don't recall what states do not allow underwriting. IL and CA are two. There are a few others.
This change is allowed during open enrollment. Several states also have a "birthday month rule. Changes are allowed during the person's birthday month.
Underwriting is a prickly issue. They can deny not only with preexisting conditions, but also if you've been prescribed certain medications. Each company has their own parameters.

That is even though they are not supposed to deny you coverage due to pre-existing condition, due to federal mandate says they are not. But the advantage coverage is not perfect and can even deny you procedures and medications. Sad but true.

 

[dick0236]

What I really want to know is why these Medicare scammers are calling me five times a day from different numbers. I won’t be eligible for 15 years anyway. And every time I navigate their robots and get to a live person, they hang up on me before I can finish telling them they’re wasting their time, remove my number from the computer!

I block and delete every number they call from and they never run out. I am on the National Do Not Call registry.

These people were driving us NUTS with 40-50 robo calls a day. I found a landline phone system that has eliminated 99+% of those calls. Vtech Smart Call Blocker VS-112.....purchased from Amazon at +/- $100 with a base unit and two remote phones. Have had it for about two months and it works fantastically well.......so far!

PS: I was on every no call list I could find and none of them were catching the calls. We still have the phone light up but no nuisance call rings......it's kinda like sitting on your deck at nite and watching the bugs burn up on your "bug zapper".

 

[MIB]

A question for MIB: You seem to have a good knowledge of the Medicare Advantage plans. Since she had to have both Part A and Part B in order to get a Medicare Advantage Plan (Part C) would she have to go thru underwriting if she opts out of MC Advabtage in favor of Original MC and a private MC Supplement during the "open enrollment" period thru Dec 7, 2023?

I am a retired agent and have had a Medicare Advantage plan since they were introduced years ago. Personally, I have been very satisfied with the concept and have used it fairly often due to my age and cardiovascular issues.

The answer is, it depends. In a few states, they're not permitted to do underwriting. In the majority of states, one will have to go through underwriting. Everyone must have Medicare parts A & B. that's true for both Advantage and Medigap plans.
The difference is advantage plans are guaranteed issue. They have to take you no questions asked, no restrictions about preexisting conditions.
Medigap plans are allowed to choose whether or not to accept a person.
I don't recall what states do not allow underwriting. IL and CA are two. There are a few others.
This change is allowed during open enrollment. Several states also have a "birthday month rule. Changes are allowed during the person's birthday month.
Underwriting is a prickly issue. They can deny not only with preexisting conditions, but also if you've been prescribed certain medications. Each company has their own parameters.

That is even though they are not supposed to deny you coverage due to pre-existing condition, due to federal mandate says they are not. But the advantage coverage is not perfect and can even deny you procedures and medications. Sad but true.

The teason why I'd never get an Advantage plan.

 

[carolinemc]

The answer is, it depends. In a few states, they're not permitted to do underwriting. In the majority of states, one will have to go through underwriting. Everyone must have Medicare parts A & B. that's true for both Advantage and Medigap plans.
The difference is advantage plans are guaranteed issue. They have to take you no questions asked, no restrictions about preexisting conditions.
Medigap plans are allowed to choose whether or not to accept a person.
I don't recall what states do not allow underwriting. IL and CA are two. There are a few others.
This change is allowed during open enrollment. Several states also have a "birthday month rule. Changes are allowed during the person's birthday month.
Underwriting is a prickly issue. They can deny not only with preexisting conditions, but also if you've been prescribed certain medications. Each company has their own parameters.

The teason why I'd never get an Advantage plan.

That is why I hesitate on the Advantage plans. I need my meds for Heart and Diabetes type 2.

 

[valveanddissection]

Some years back, 14, I had an ascending and descending Aortic Dissection, an emergency. Immediate surgery, 14 hours worth, resulting in replacement of the aortic valve with a St Jude mechanical and a Bental Graft. The bill for surgery, 16 days in ICU, and 2 subsequent code blues exceeded $800,000 dollars. So What. I am alive! I’ve Had a few battles with the insurance company: won most, lost a few. Sign the forms and live on to fight whatever if anything they throw at you on another day. Or, take a similar chance: don’t sign the forms, and maybe live a long life; or die tomorrow? Who knows? We don’t.
Good luck with your decision.

 

[atlantadoug]

In 2 days I’m supposed to be flying to the CC, BUT how I have been treated is unlawful and unacceptable.

I feel like I have been badgered by a number of people in the Surgeon’s office and in Surgical Registration. They all say one thing about the financial arrangement but they won’t put it in writing. They want me to sign a document that obligates me to signing the equivalent of a blank check and ignore what the document says!

The document states, “I agree to be financially responsible and obligated to pay CC for any balance not paid by a Third Party Payer.”
They claim I won’t have to pay anymore than the insurance company’s maximum out of pocket. The insurance company denied coverage.
CC lead me to believe they filed an urgent appeal, which it turned out they didn’t do.

Today Dr. Vargo’s office sent me an email saying they just received an email from my insurance co. and a appeal has been approved.
I called the insurance co. and there is no appeal that been approved!

I can’t do this with these verbal statements of “just trust me” and “never mind what the contract says” when were talking about hundreds of thousands in medical bills!

Did anyone sign such as blanket financial statement? If so, how did it turn out?

Hi Karen, I had OHS to replace my aortic valve back in 2011 at Cleveland Clinic. I received nothing but the finest care from all I encountered. They truly are the best in the field, and when it comes to your heart you want the best. My Surgeon was Lars Svensson. I had employer sponsored insurance so I payed what they didn't I suppose. I remember my portion being about $7k I think. The surgery was well over $100k back then. Either way, every facility is going to have you sign something that says you are responsible for charges not covered by your insurance company. If they said they got an appeal approval ask them to see that in writing. There must be some documentation of it. I hope you get this settled so you can focus on your surgery and healing. You got this!

 

[KarenK]

Hi Karen, I had OHS to replace my aortic valve back in 2011 at Cleveland Clinic. I received nothing but the finest care from all I encountered. They truly are the best in the field, and when it comes to your heart you want the best. My Surgeon was Lars Svensson. I had employer sponsored insurance so I payed what they didn't I suppose. I remember my portion being about $7k I think. The surgery was well over $100k back then. Either way, every facility is going to have you sign something that says you are responsible for charges not covered by your insurance company. If they said they got an appeal approval ask them to see that in writing. There must be some documentation of it. I hope you get this settled so you can focus on your surgery and healing. You got this!

I would expect to sign a doc saying that I was responsible for charges not covered by the ins. co. If all had been going smoothly with the CC I would not have had a problem signing it but the CC's misleading, conflicting behaviors and their failure in filing appeals and then lying to me about it and on two separate occasion falsely said an appeal was approved.

I was told an urgent appeal was filed, then later contacted when a response was due on the appeal and told the urgent appeal was denied. They lied, they NEVER filed an urgent appeal and they had about 2-3 wks. prior to the surgery date to do it.

Then 2 days before I was to fly out, I received an email saying that an appeal had been approved. I asked the CC for a copy of the approval. CC's emailed back admitting they did NOT have approval.

Absolutely everything went like the above... from medical issues, bleeding history, additional tests, estimates, etc. It felt like I was being sold, not assisted in the process, or I was an annoyance and say whatever to get me off the phone. Maybe I got a poorly run surgeon's office. Certainly everyone's experience isn't like this.

The fact that they failed in dealing with the ins. on the frontend, made me question if they would on the backend which could end up in a lengthy process or they could just come after me instead. Seems like a much simpler process, then dealing with the ins. co., only one simple court order and they could put liens on my home etc. They may even benefit financially more this way.

Originally my surgeon was Dr. McCurry, then when I set up my portal it said Dr. Umana so I called and questioned this. I was told Dr. Umana was a great surgeon with 20 yrs. experience. Some facts were withheld so I couldn't make an informed decision. The Dr. was brand new to the CC, brand new to this country from Bolivia, and a pediatric surgeon. He was hired for the Florida location, but was in Cleveland for surgical training and experience in the U.S.
I also saw an article where surgeons from Texas were going to Bolivia that were training him in some cardiac surgical procedures.

Even after I spoke with the NP about this an requested another surgeon, another person later tried to sell me again on Dr. Umana and insisted he has been at the CC for 20 years! My trust in the CC has faded.

 

[Chuck C]

Hi Karen..

Did you find a hospital which you were comfortable with and have you had your surgery yet?