Case-in-Point


Part of the January 2014 News to Use prepared by Dale Last at the CO-WY Chapter of the NMSS included this advice:

On Medicare Advantage?  Make Sure Your Doctor is Still in Your Plan

PaperworkSome physicians around the country are being dropped from Medicare Advantage networks and several MS neurologists have been speaking out about the issue, concerned that people with MS will feel the impact if their doctors are dropped.

The American Medical Association and approximately 90 specialty societies have taken the lead to address this with the Centers for Medicare and Medicaid Services and the National MS Society is working with the American Academy of Neurology to track the issue and determine impact.  People currently on Medicare Advantage plans that find that their doctor is no longer part of the plan are able to switch back to Original Medicare between January 1 and February 14.  See Medicare Interactive for more information.

Shortly after forwarding this info to others with multiple sclerosis, I received this reply email containing a cautionary tale . . . the names have been removed or changed . . .

Might want to pass this on:

I encountered a small shock this afternoon.  I had a scheduled appointment at [the MS Center] with [my doctor] today, first appointment after my [drug] infusion (which there is now only one infusion every six months.) I checked in, only to be informed that [the MS Center and hospital] no longer accept my Medicare Supplemental / secondary insurance: as of January 1. 

I have had that policy since I started Medicare Part B back in 2009.  Never thought to check if [the MS Center/hospital] was or wasn’t participating this year.  After all, they always have AND well it’s [my big-name insurance company], right?!

So now I am on the hook for 20% co-pays at [the hospital].  My policy covers everything above whatever Medicare pays, at least for participating providers.

Can’t go back retroactively and change plans for 2014, of course.  My error for not researching carefully this year and taking things for granted.  My other providers are still taking [my big-name insurance company].

I just won’t be doing any overnights or surgeries at [that hospital].  As it turns out, the actual co-pays, as far as I have calculated them so far, for things like visits with [my doctor], his P.A., labs, etc. are minimal. But I will have MRI and other procedures done elsewhere.

Moral of the story: check your provider lists each year.

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