How to make insurance provide coverage to those that need it?

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How to make insurance provide coverage to those that need it?

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I have been fighting with Medicare Advantage plan, Preferred Care (owned by United), as they do not honor their responsibilities, as outlined by Medicare. In addition, when I contact Medicare, depending on "person", I get someone helpful, but have to allow 30 days for insurance co to respond, then when I call Medicare back, they say they have no authority on Advantage Plans??? In the meantime, my father is being denied NEEDED care.

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It sounds like you may need to read the fine print on the coverage he actually has to make sure the services your dad needs are actually covered by his plan. I had this issue with a client that needed adult day services. Those services were not covered under the plan she had. She actually had to switch to another plan. The catch will be whether or not you can actually switch your dad (if his services are not provided for in his current plan) right now. You may have to wait until open enrollment in November I believe.

If your dad needs Home Health Services then you do need to have an order (or prescription) from his doctor stating he needs those services. Home Health Services usually covers services from a nurse, home health aide, medical social worker, PT, and OT. If your dad needs regular in-home attendant care (help with activities of daily living) then this is different from Home Health Services. These are the services that may not be covered by his plan. These services are sometimes covered by Long-term Care Insurance or Medicaid if he is low income. A Vet can get these services under the Aide & Attendant Program. Medicare does not cover long-term care. Good luck!

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What is it that your Dad needs? Does he need some type of therapy as Medicare will cover someone coming to the house for a half hour to hour to do therapy, as long as you have a written script by your Dad's doctor. Usually the doctor will give you names of therapy groups to call.

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You might be better off with a MediGap plan. Medicare.gov might be a good resource for you.

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PCP Doc has to write individual RX's for each ADL or issue needing help. One for home health aide for bathing, one for physical therapist, one for occupational therapist, one for RN visits, etc., specifying how often each specialist and service is authorized. The PCP Doc's office knows what contract firms are authorized by what Medicare Advantage Plan. Once you have jumped through these hoops, then getting the required services is routine. However, getting top-notch people from the authorized firms will present you with a different challenge to your coordinational, social, and negotiation skills. Best wishes to you.

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This might be a long shot, but you could research which federal and state legislative committees have jurisdiction over or focus on health care (specifically health care providers), contact them, explain the dilemma and ask if there are federal or state statutes which address standards of performance by the health care providers. Maybe someone who's running for re-election would be willing to add a constituent rescue to his/her platform of accomplishments.

A long shot, and perhaps questionable in terms of your specific situation, is to also research locally and nationally as to whether United has been sued for similiar behavior and lack of cooperation. If so, you might want to consider consulting an attorney for some extra legal muscle in dealing with United.

If you don't mind the publicity, you can reach out to media, such as local news channels. They enjoy coming to the rescue of citizens battling big business.

In the meantime, I would start researching Medigap or other plans. The kinds of problems you're having are a primary reason why we've stayed away from these companies that repeatedly send out solicitations and actively recruit clients.

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Contact your local SHIP volunteers! State Health Insurance Assistance Program.
They can assist hands on to resolve your issues with MEDICARE, SUPPLEMENTS, & ADVANTAGE plans. They also assist finding a new plan if your are unhappy with the one you have.

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Be aware, Medigap does not offer prescription plans. My Mom gets state help.

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ssands1: I strongly suggest that you find an insurance agent to work on your behalf. We did here in Maryland, free of charge. If not, then I would #1 sign up for online, #2 get the name of the person you speak to each time you call and #3 call every day! When you say you are calling Medicare and get a response-"they don't have any authority on Advantage Plans."- are you sure that you're calling the right Medicare?

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You have reached a dead end with your "United Advantaged Plan". And yes "Medicare" has no involement with them other than to send them the money sent in from sociai security..

You need to drop this plan and pick up another "Advantage Plan" that has the benefits you want. Look at Anthem, Humana, Aetna or AARP. ehealthmedicareplans will help you compare plans.

Another option is to get "original" Medicare with Medigap (also called Medicare Supplement). Read everything on medicaresupplement

Remember agents get commissions and give kickbacks. So they are not necessarily in your corner.

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ssands1: I also have Medicare and Medicare Supplemental (through AARP, United Health Care, Plan F.) Are you getting confused with Medicare.gov and Medicare Supplemental? The phone # for United Supplemental is 1-800-523-5800. I don't understand why you are waiting 30 days for an answer. You stay on the phone with them until you get a satisfactory response and ALWAYS get the person's name. It would be in your father's best interests to set up online accounts with Medicare.gov and his Medicare Supplemental. AND MY INSURANCE AGENT WAS DEFINITELY IN MY CORNER, snowquail, with no cost to me or my Medicare or my Medicare Supplemental.

How to make insurance provide coverage to those that need it?

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