I was on the phone with various Humana agents for about 45 minutes, being ping-ponged from one to another. They do not have an HMO presence in my geographic locale but as a "provider" I may accept their Medicare Advantage/PPO members and bill the insurance company without any contracts. Or so they say. The current issue I am facing is that I am being treated as a primary care provider when in fact I am a specialist, a dermatologist. The copayments are different. I trained as a dermatologist and my claims need to be processed as such, not by a random high school dropout who sees my claim and does the automatic rote thing. I fight daily for such small humiliations to be removed from my hair.
For those of you who do not know, Medicare Advantage plans were all the rage in Florida as the new kid on the block about 4 years ago. They were "rushed like a fraternity in September" because they promised senior citizens zero out-of-pocket charges and they tossed in little goodies like gym membership discounts or prescription plans. In sum, seniors get Medicare premiums docked from their Social Security checks. Yes, that's right, what you "paid into" all those years as a working stiff is no longer enough, you must continue to pay for it even from your Social Security check. Then they are subject to a $140 calendar year deductible and 20% copayment of the allowed charge for all outpatient, or Part B, services.
When the retiree joins these Advantage plans, they no longer get the Medicare premium docked from their Social Security check. The Medicare Advantage plans get government grants, in a lump sum, to cover the senior citizen, and then they "deliver" services at a bundled rate. Part of that sum goes towards advertising and promotion, so government is funding non-medical activities in this method, by feeding a private sector entity. Patients pay a flat copay at office visits, somewhere between $15-50 depending on the plan they choose. Specific drugs, labs, etc must be used, and only doctors who accept the plan can be seen by the retiree. A doctor does not have to accept the plan even if they are a participating doctor with Medicare. There is a different fee schedule (LOWER OF COURSE) and more restrictions on types of services covered.
The controversy came in when fast talking salespeople came to town and offered seniors free coffee and donuts to get them to switch to their HMO-like system. You all know that people would sell their souls for a jelly donut. The insurance agents got huge commissions and bonuses for signing seniors up in bulk. The rude awakening came when plans over-promised and under-delivered. The infamous "Any Any Any Plan"-- literally that was the name of a certain Tampa-based plan-- got shut down by the feds for not paying doctors and hospitals and they went bankrupt. I refused to accept that plan many a time (simply because of their absurd name) and I faced harsh words from my patients who were on this, only to then hear their lamentations when the plan got busted. Sorry Charlie. If you yell at me I won't be your doctor.
In any event, I'll wait and see what happens with Humana. If they can't correct the glitch in their system that doesn't recognize what I do, I'll refuse to deal with them any further and drop it. I had long standing patients switch to their Advantage Plan and I took it and billed it, got paid within 14 days, and all was fine, until I read the fine print and saw they weren't able to code me as a specialist for mysterious reasons. We shall see if they will fix it. I'm not holding my breath.
Update on 10/15/2012: Not one letter, phone call, nor follow-up to this situation has occurred. They haven't done one thing. I'm tired of this BS so I'm dropping it. Stick a fork in me. I'm done.
Clear Stream
