I just went the traditional route and got a Blue Cross plan as my supplement because Blue Cross is the one they prefer above all others.
I have Blue Cross, too. I've always had it for that very reason. I remember the office staff always lighting up when I said "federal Blue Cross." I thought that continued with Medicare because I thought that Blue Cross paid the provider up to the Blue Cross allowed amount, which would typically be greater than the Medicare amount. But I found out recently I was wrong about that. Blue Cross can only be billed/pay the difference between the 80% or so of the Medicare amount that Medicare typically pays and the Medicare amount, that is, the co-insurance/co-pay. So now I have no clue why providers would prefer Blue Cross. They don't get any more money from them. Perhaps it's that Blue Cross has a simpler oricess or more timely or some such but it doesn't pay better. So I can't explain why it would be preferred.
All I know is that I paid the normal, full fee for the type of exam I had.
That's probably because your exam wasn't covered. Medicare doesn't care what you pay for things it doesn't cover. Had it been your first exam for the year, you couldn't have paid the normal amount had you wanted to.
I'm having a heart scan next week and I'm paying out of pocket the regular price. Neither Medicare nor Blue Cross pays for that procedure.
There may be regional differences, too.
I'm a long way from figuring what state role there is, if any. Haven't yet located a single source. Nothing I've read suggests a state role.
Even with the national system, it's hard to find out what goes on behind the curtain, not without paying a consultant for the info, at least. Of course, that just makes me even more curious.
They're quite a bit lower than Medicare even, and a Medicaid recipient here has to really search to find willing doctors.
I was in the waiting room of an orthopedist a couple of years ago and happened to overhear a phone conversation from the front desk. Someone was trying to make an appt. When told it was Medicaid, the desk person told the caller that there would be a Medicaid slot in a couple of months. I had gotten an appt in a few days. The doctor only takes so many Medicaid patients. That's what lead me to understand the risk for Medicare patients, as well, going forward. When I was looking for a new primary a few years ago, I was surprised at how many didn't take Medicare. It's not going to get better. With Medicare I feel like that joke about how fast you have to be to outrun a bear--you need only be faster than the other guy. We have the advantage with Medicare that providers are compensated better than the folks with Medicaid so we have a better chance. Surviving at the expense of someone in an even worse system does not make me feel all warm and fuzzy. |
