Humana and Spinal Cord Stimulators

[TeslaCoil]

Anybody even try to get these approved? They want proof of CBT? PT? Surgery consult? dates and times? wtf

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[buddababa]

Anybody even try to get these approved? They want proof of CBT? PT? Surgery consult? dates and times? wtf

i basically tell people to leave humana/aetna. terrible

 

[swamprat]

I have no problem down

I had issues with obamacare plans and getting it approved for needing a note from surgeon stating no more surgery indicated but that seems to have backed off a bit this year.

I have had issues with bc/bc and lumbar fusions wanting some comprehensive psych thing which a reg psych eval doesn't seem to work. peer to peer MD couldn't really even explain it to me further

 

[Laryngospasm]

Yes.. you definitely want to try all the fusions cages and screws you can and spend a million or so before considering scs.. we get paid **** for doing them.. surgeons still making millions.. wth do they think we want to put them in?

 

[Ferrismonk]

Yes.. you definitely want to try all the fusions cages and screws you can and spend a million or so before considering scs.. we get paid **** for doing them.. surgeons still making millions.. wth do they think we want to put them in?

To make a bunch of money on expensive treatments that don't actually "fix" anything.

 

[BobBarker]

I haven’t noticed any issues. Maybe 30% of my practice is Humana.

 

[bedrock]

I tell everyone patient on medicare advantage plans that the advantage is the reason anything was denied/not covered and recommend they switch back to regular medicare. It's a personal mission of mine as those advantage plans are so terrible.

 

[Laryngospasm]

I tell the patient they misunderstood and what they actually have is a disadvantage plan

 

[Agast]

It’s hard to switch back from advantage to regular Medicare. My patient couldn’t because he was diagnosed with spinal stenosis while on the advantage plan, and he said the other plans (maybe supplements?) won’t take him due to the pre-existing condition

 

[soccrwz]

It’s hard to switch back from advantage to regular Medicare. My patient couldn’t because he was diagnosed with spinal stenosis while on the advantage plan, and he said the other plans (maybe supplements?) won’t take him due to the pre-existing condition

Changing from Medicare Advantage to Original Medicare is a very simple process once you’re ready and eligible to switch. There are three ways you can make the change:

1. Visit your local Social Security Office and ask to be disenrolled from Medicare Advantage;
2. Call 1-800-MEDICARE (1-800-633-4227) and process your disenrollment over the phone; or
3. Contact your Medicare Advantage insurer directly and request a disenrollment form.

The easiest way to move from Medicare Advantage to Original Medicare is during one of two annual periods that allow anyone to leave Medicare Advantage with no questions asked.

How to Switch from Medicare Advantage to Original Medicare – MedicareGuide.com

If you discover that switching from Medicare Advantage to Original Medicare is better for you, you can change your coverage during Medicare open enrollment.

medicareguide.com

 

[Agast]

Changing from Medicare Advantage to Original Medicare is a very simple process once you’re ready and eligible to switch. There are three ways you can make the change:

1. Visit your local Social Security Office and ask to be disenrolled from Medicare Advantage;
2. Call 1-800-MEDICARE (1-800-633-4227) and process your disenrollment over the phone; or
3. Contact your Medicare Advantage insurer directly and request a disenrollment form.

The easiest way to move from Medicare Advantage to Original Medicare is during one of two annual periods that allow anyone to leave Medicare Advantage with no questions asked.

How to Switch from Medicare Advantage to Original Medicare – MedicareGuide.com

If you discover that switching from Medicare Advantage to Original Medicare is better for you, you can change your coverage during Medicare open enrollment.

medicareguide.com

You can still get shut out of the supplement plans. Remember Medicare only covers 80%

https://www.ehealthmedicare.com/faq/which-pre-existing-conditions-are-not-covered-by-medicare/

“While Original Medicare doesn’t restrict coverage based on pre-existing conditions, the rules are different for Medicare supplemental insurance plans. Private Medicare-approved insurers can turn down your application because of a pre-existing condition if you don’t sign up during your Medigap Open Enrollment Period.”

So Advantage plan patients may find that they are unable to afford switching back to regular Medicare

 

[soccrwz]

You can still get shut out of the supplement plans. Remember Medicare only covers 80%

https://www.ehealthmedicare.com/faq/which-pre-existing-conditions-are-not-covered-by-medicare/

“While Original Medicare doesn’t restrict coverage based on pre-existing conditions, the rules are different for Medicare supplemental insurance plans. Private Medicare-approved insurers can turn down your application because of a pre-existing condition if you don’t sign up during your Medigap Open Enrollment Period.”

So Advantage plan patients may find that they are unable to afford switching back to regular Medicare

You said regular Medicare not supplemental in the previous post, supplemental plans just like other insurance plans whole another ball game

 

[Agast]

You said regular Medicare not supplemental in the previous post, supplemental plans just like other insurance plans whole another ball game

I did mention supplementals. Most people aren’t going to do straight Medicare because the 20% is too big to swallow

 

[10KHertz]

Medicare contractors will be trying to take back money on all our procedures . Every new LCD is a tool to screw us . Make sure you get the psych clearance for all stims.