|
Post by The Walk of the Penguin Mich on Oct 19, 2016 13:01:14 GMT -5
I agree the network is very large. I can't remember the last time I wanted to see a dr, and they were not in-network. Some walk in clinics are not in network, but I have also figured out if a hospital's emergency room is in-network, their associated walk in clinic is probably also in network b/c they bill under the same taxpayer id.
Be careful with this assumption. In my experience, I have had doctors, labs, radiologists and physical therapists all associated with a hospital, but out of network. The way they get around it is that they are on contract with the hospital.
|
|
justme
Senior Associate
Joined: Feb 10, 2012 13:12:47 GMT -5
Posts: 14,618
|
Post by justme on Oct 19, 2016 13:48:03 GMT -5
interesting. my prescription isn't one that I fill regularly on a schedule. I wonder how that's going to work. hmm... I think it depends on what the drug is. Maybe whether majority that take it take it as maintenance or not? It hasn't been too big of a deal for me because the mail pharmacy is a better price. The main issue is to make sure doctors write the script for three months cuz if they only write one month they'll still send it and charge you the three month copay regardless.
|
|
swasat
Senior Member
Joined: Apr 13, 2011 9:34:28 GMT -5
Posts: 3,735
|
Post by swasat on Oct 19, 2016 13:52:33 GMT -5
Except for my hsa before I hit deductible, I've always had the standard varying co-pays for rx. I think express scripts is in charge of most if not all of their rx coverage. my brochure says a company called OptumRx. I would imagine I can still use my local CVS though, right? You absolutely can. Optum is wholly owned sub company of UHC. How do I know? I used to work for UHC Technology a decade ago Optum is just the prescription administration/management branch of UHC. You still go through a regular pharmacy who then goes through Optum. No, copay is different than coinsurance. Copay: Your copay is a predetermined rate you pay for health care services at the time of care. For example, you may have a $25 copay every time you see your primary care physician, a $10 copay for each monthly medication and a $250 copay for an emergency room visit. Coinsurance: Coinsurance is a percentage of a medical charge that you pay, with the rest paid by your health insurance plan, after your deductible has been met. For example, if you have a 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%. Not sure why it was different each time for you chiver. Do you have HSA? The only time I see changes in my out of pocket costs is when I have reached the deductible. But the too my "copay" remains the same, I just have to more/less money through HSA.
|
|
|
Post by The Walk of the Penguin Mich on Oct 19, 2016 13:59:01 GMT -5
Not sure why it was different each time for you chiver. Do you have HSA? The only time I see changes in my out of pocket costs is when I have reached the deductible. But the too my "copay" remains the same, I just have to more/less money through HSA.
Some drugs have copays that are a certain percentage of the cost, I know mine is this way.
|
|
mollyanna58
Junior Associate
Joined: Jan 5, 2011 13:20:45 GMT -5
Posts: 6,671
|
Post by mollyanna58 on Oct 19, 2016 14:04:00 GMT -5
My parents have had UHC/AARP Medigap coverage for 2 years. They have used either Walgreens, Rite-aid, or a couple of local pharmacies for prescriptions. Mail order Rx is encouraged, but not mandatory.
I have been POA for 1.5 years. I have not received a bill for anything except prescriptions. Between Medicare and UHC, everything else has been covered, with no problem.
Now, I did ask them to update my mother's mailing address a few months ago, and that hasn't been done. I have to call again about this.
|
|
travelnut11
Familiar Member
Joined: Feb 12, 2011 22:17:14 GMT -5
Posts: 639
|
Post by travelnut11 on Oct 19, 2016 14:05:17 GMT -5
I think this hugely varies by where you live and the contracted plan your company pays for. I live in a unique health insurance market in that there several local insurers so a lot of the big national insurance networks aren't common around her. When I worked for United Health Group I was put on a special plan called Options PPO because none of the docs/hospitals in my area were on regular UHC networks. This worked pretty well...I had plenty of options though within only one of the two hospital systems in the city.
When UHG spun us off I still had UHC insurance but my company had a different plan set-up and they didn't know anything about Options PPO. I'm a remote worker so there's only 1 or 2 people in my area working for my company. It became a logistics nightmare because they had to manually update my plan to Options PPO every week when the database was refreshed and if they didn't do it then all of my submitted claims showed up out-of-network. Grr...it was so annoying and at the time I was only going to the doctor once per year. I did finally escalate it when I got pregnant and had a senior guy at UHC making sure my claims were on the up-and-up so I will say once I got to the right person they handled it well. It really wasn't UHCs fault but rather my company's fault.
In the end I got married and switched to my husband's local insurance plan which is much better and covers any doctor/hospital in the city. My company has now switched to Cigna and I've determined already there are doctors in my city with them if we need to switch. Of course it's with the other hospital system but I don't really care as long as I can stick with my current OB through the end of my pregnancy... less than 16 weeks to go!
ETA: mail-order is awesome! Drugs are cheaper and come to your house...no trips to the pharmacy.
|
|
973beachbum
Senior Associate
Politics Admin
Joined: Dec 17, 2010 16:12:13 GMT -5
Posts: 10,501
|
Post by 973beachbum on Oct 20, 2016 6:46:14 GMT -5
I liked UHC better than Amerihealth for customer service. Although the Amerihealth dashboard is pretty easy to navigate and get answers to my questions like if a claim was paid. But the times I have called they have been pretty quick and easy to get the info from. We really aren't heavy users though. If we had medical problems it might be different. Our big problem lately has been that the work insurance has always been an hmo. It works fine for me when we are in our little area, but DD now goes to college three hours away. In order for her to use it she has to either come home or call the number and get it preauthed. It wouldn't be a problem for me but teenagers just go to the Dr because they are dying and afterwards say sorry about the bill. I could make her pay it but then it would just be less money going toward tuition and books. There really is no way to make that less actual money out of our pocket. My other problem is the networks now are very state lines driven. So my kid can go to the Chop pediatrics office for regular stuff but the Chop hospital just across the bridge is out of network. Same company just a different billing address.
|
|
kjto1
Established Member
Joined: Jan 13, 2013 13:47:03 GMT -5
Posts: 485
|
Post by kjto1 on Oct 20, 2016 7:02:14 GMT -5
my brochure says a company called OptumRx. I would imagine I can still use my local CVS though, right? Yea. The only thing is I know on certain meds you only get to fill them like two times at a retail pharmacy before you're forced into the mail one. They say it's for preventative meds but a few of my as needed meds get forced there. I think I had optum when I was on the weird bcbs one. I have UHC. I received the letter that I could only fill 2x at retail pharmacy. I had the option to decline mail order scripts - however, I had to call them and tell them I decline, and I can continue using retail pharmacy.
|
|
Ryan
Senior Member
Joined: Jun 16, 2014 13:40:36 GMT -5
Posts: 2,202
|
Post by Ryan on Oct 20, 2016 9:02:41 GMT -5
I've had UHC for 5 years and they are great. ..no issues.
|
|
Anne_in_VA
Junior Associate
Joined: Dec 20, 2010 14:09:35 GMT -5
Posts: 5,510
|
Post by Anne_in_VA on Oct 20, 2016 9:41:10 GMT -5
I now have BCBS and just got a letter stating that I am required to use the mail order pharmacy as of January 1st. So now I need to call my doctor to ask her to write new scrips for the two Meds I take so I can get it ordered before the end of the year. From what I've heard, it seems many insurance companies are going this way.
|
|
wvugurl26
Distinguished Associate
Joined: Dec 19, 2010 15:25:30 GMT -5
Posts: 21,723
|
Post by wvugurl26 on Oct 20, 2016 9:57:27 GMT -5
I'd be okay with getting pills via the mail. I've heard horror stories about other stuff getting ruined by the elements. It gets very hot in the summer and pretty cold in the winter. Those aren't ideal conditions for my eye drops or inhalers.
|
|
dee27
Senior Member
Joined: Sept 28, 2016 21:08:12 GMT -5
Posts: 2,211
|
Post by dee27 on Oct 20, 2016 10:10:19 GMT -5
I have Medicare/UHC supplemental and I have UHC for my drug plan. The medical portion has been problem free, but the drug portion has not. Optum RX's website is often slow or not working and the reps are not well versed in helping customers. Optum changes the formulary to benefit those who take generics. The premiums rose again this year. There were price increases in co-pays (generic and brand) this year. My co-pay for one brand medicine rose from $250 to $611, but the over the counter cost for the medicine has only risen $30.00 over the last four years. For a 90/day supply, Optum overrides the doctor's prescription if it is more than one pill per day. The second refill is short x amount of pills.
|
|
daisy
Familiar Member
Joined: Aug 24, 2013 0:43:49 GMT -5
Posts: 739
|
Post by daisy on Oct 20, 2016 10:13:41 GMT -5
We call them Useless Heath Care. I used to have a plan through the hospital where I worked that covered EVERYTHING any of us needed done...now we are all on DH's UHC and it seems that NOTHING is covered. DH has a plethora of health issues and is CONSTANTLY on the phone arguing with UHC about not covering this or that - and he has to get is Primary doc involved all of the time to justify her orders. He had a 'poop' test, the same one he's been getting for 8 years now...and they won't cover it. The company appealed, UHC refused to cover it and now DH has to call, ask his Primary to call...It's INFURIATING!! It's the SAME TEST you've paid for for 8 years, our plan has not changed at all, so why refuse to cover it now? Of course, this is the same test UHC sent out a notice that he was required to have, being 58 - not that he hasn't had the same test for 8 years - he has to be TOLD to get it. He is retired and the UHC insurance costs us next to nothing monthly so I find myself arguing that it's worth it because our cost is so low....but the frustration is annoying. He is literally on the phone with them once a week to contest a charge or a bill. PLUS, the kicker for us was, he's been divorced for 10 years...guess who has been on his insurance plan up until about a year ago? Yeah, that would be the ex, despite UHC being notified the minute the ink was dry on the decree. Guess who WASN'T on UHC...yeah, that would be me, the new wife of 6 years, despite him providing the required paperwork as soon as the ink was dry on the marriage certificate. UGH And one year they 'lost' one of my children, despite her having been covered for several years before that. Yeah, we hate UHC with a passion and it's almost worth me getting another hospital job just for the insurance. Maybe when we finally move to our retirement destination. It's something I'm seriously considering.
|
|
bean29
Junior Associate
Joined: Dec 19, 2010 22:26:57 GMT -5
Posts: 9,962
|
Post by bean29 on Oct 20, 2016 12:05:04 GMT -5
I agree the network is very large. I can't remember the last time I wanted to see a dr, and they were not in-network. Some walk in clinics are not in network, but I have also figured out if a hospital's emergency room is in-network, their associated walk in clinic is probably also in network b/c they bill under the same taxpayer id.
Be careful with this assumption. In my experience, I have had doctors, labs, radiologists and physical therapists all associated with a hospital, but out of network. The way they get around it is that they are on contract with the hospital. It wasn't an assumption per se. My family uses a few local walk in clinics. We had used one say 12 miles from the house which was part of Aurora Hospital's network (Huge, one of the largest in the country). DD in previous years had gone to an aurora walk in clinic about the same distance from the house with slightly different hours in prior years, she got a Migrane at work and required meds, and had a friend take her to that clinic. While she was there I was checking the insurance web site to see if it was in-network, and it was not listed despite the fact that some others were listed. She was given an IV with anti-nausea drugs while she was there, so I was very worried that it would be deemed out of network, and not covered. It was paid without a hitch.
Then later that year, our closest ER opened a walk in clinic about 2 miles from my house. It was not listed as in-network on the insurance web site, but my kids were looking for treatment for some issues that had hours they could access when driving home from the college they attend. The college is only a little more than an hour from home, but to access medical care they would have to drive at least a half hour. 30 mins or an hour drive is not a lot of time when the providers and quality of care are better known. I wanted DD to use the Wheaton Franciscan Clinic b/c her regular Dr. is a Wheaton Franciscan Dr. and when you go in there they can see your medical history and call up the meds you are on. So I called the insurance to verify if we could use that walk in clinic. The rep initially told me they were not in-network, but offered to call them and verify. She called me back within an hour and said she would not be able to verify until the next day, as whoever she needed to talk to at the clinic was out for the day. She called me back the next day and said that since they bill on the same taxpayer id as the main ER, all claims would be fully covered. We have used the walk in clinic there since, and my claims were paid.
I try to make the insurance pay for everything I can, but I am not unwilling sometimes to pay out of pocket for convenience. Even though I have had the thought that I am willing to pay out of pocket for convenience, I have yet to actually have to cough up for any denied claims. We had to pay once. I took DS to an Aurora walk in clinic in the same practice where DD's Doctor practiced. She actually saw walk in clinic customers some times. The claim was denied, and I paid OOP. That is why I usually do try to do the legwork to make sure the insurance will pay. When DD had that migraine and she was in so much pain, I just did not want to say wait you need to drag your butt somewhere else, so I just figured "Que sera sera". Luckily it worked out ok.
|
|
copperboxes
Initiate Member
Joined: Aug 22, 2015 9:16:33 GMT -5
Posts: 91
Location: 7a OK
|
Post by copperboxes on Oct 20, 2016 12:34:54 GMT -5
We had UHC for DH's previous job. Not a fan, though we only had a small sampling since DH is extremely healthy and I tend to just self patch.
We used it once, DH had to get an immunization for travel. While he was there, the doctor offered to give DH a checkup since it'd been a very long time since DH was looked over. DH said sure. They drew some blood, the doctor sent it for a panel of preventative tests.
The bill had 2 flat errors, we were charged for 2 preventative tests. Those were refunded when I called.
We were also charged for the cholesterol test. When I asked about that, since the paperwork handed out and their website has cholesterol tests specifically listed as an example of preventative care already covered by premiums, the rep couldn't see why we were charged and sent me to a specialist. According to the specialist there are age brackets for many preventative tests, and DH did not fit the right age bracket. I gather the age bracket was deep in the billing code description at their end.
I asked, there is no data sheet individuals can refer to for preventative testing. According to the specialist, data on what tests will count as preventative is entirely on their side and details change often. If we want to know in advance, we have the option to get specific medical billing codes from the doctor first, call UHC, inquire, and it was recommended to be sure to specifically ask about age brackets.
The conversations went mildly and the rep seemed relieved I wasn't angry. It was mostly just data gathering as the charges were small. Mostly it just did not inspire confidence, putting it quietly. I understand preventative tests to be the most routine and basic of all medical interactions. This lack of clarity and volume of errors seemed a bit much.
We have not had to use any other insurance companies though, so I don't know if this is the general state of healthcare, or if it was just UHC in our region.
|
|