united health care coverage

Questions and answers about medical benefits, severance pay outs. etc.

united health care coverage

Postby vz353 on Tue Apr 16, 2019 1:53 pm

I'm wondering if anyone has had any experience with UHC Advantage plan and major surgery. I'm about 1 to 2 years away from a knee replacement, and will enter the UHC plan this year in October. Currently I have the BlueCross BlueShield EPN plan and so far very satisfied with the coverage.

I have considered having the surgery this summer in July because, one I will need the replacement soon, and two because my current coverage will still be in place.

I don't want to jump the gun but at the same time evade a problem with the new coverage.

Any thoughts on the matter?
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Re: united health care coverage

Postby retiredandhappy on Mon Apr 22, 2019 10:03 pm

My husband went on UHC Advantage Two years ago. I was still on BC until this year. BC is much better than UHC Advantage Medicare. UHC will only pay what Medicare will pay and only for things Medicare covers. One Verizon retiree took a year to get approval from Medicare for a knee replacement, she had to go though loops to prove she really needed it. Another difference When my husband ended up going having 911 called because he passed out and wasn’t lucid the hospital wouldn’t run any tests other than blood work and out him in observation over night. They sent him home and told him to see a cardiologist. On BC years ago when he had sharp pains the hospital ran lots of tests and found out what cause the pains.

I am finding there are different medicines approved by VZ for Medicare Advantage Express Scripts than before I went on it. You may want to get the surgery done first. My guess is your deductible is paid, once you go on Medicare your deductible starts again. My birthday is mid December so I had a new deductible in DEC then a new one in January. Also with Medicare Advantage you have to pay your deductible plus your copay until you pass the copay amount. Make sure the doctor you want accepts Medicare. Many don’t.

It gives you lots to think about.
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Re: united health care coverage

Postby vz353 on Tue Apr 23, 2019 9:33 am

Thank you for the advise, I'm leaning on doing it now.

Are you on UHC HMO or PPO.

Yes, you are correct a lot to think about.

Thanks again
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Re: united health care coverage

Postby jer on Tue Apr 23, 2019 7:01 pm

You may want to check into supplemental plans for standard Medicare. 'Most' providers actually do take Medicare-it's the Medicare Advantage plans they are hesitant about. All rates paid to providers are based on CMS/Medicare rates. A Medicare Advantage plan may offer perks but you most likely cannot pick what provider you want to see.
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Re: united health care coverage

Postby Broken Man on Wed Apr 24, 2019 2:54 pm

I have been on Humana Medicare Advantage PPO plan for years, and I sometimes am a heavy user of services. I have never had anyone be hesitant with my insurance, and I often hear "your insurance is great" from the office staff.

Perhaps my good fortune is because I live near a major metropolitan area where there are scads of providers. If doctors/providers decline medicare advantage plan, they would be losing a great deal of business around me (west coast of Florida, near Tampa).

As well, I would check out whether you have a deductible or not, I don't have one for medical, or drugs. I do have a co-pay on some services, and a max out of pocket.

My wife is having both knees replaced, and you do have to go through certain procedures, which is fair as sometimes other treatments work. First was physical therapy, then injections, now it is up to replacement, first leg in June.

Good luck!

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Re: united health care coverage

Postby jer on Tue May 28, 2019 2:48 pm

Doing more research as my spouse actually now qualifies for Medicare and has Medicare with a Supplement. I still have a few months to go. I'm in Tampa and the UHC plan shows every physician/hospital I would use accepts the UHC plan. With Humana, there are gaps and it is also an HMO, where UHC is a PPO and I can go where I want without referrals. My issue is verifying info with this companies. I've got UHC down as far as what they cover, but when it comes to drugs, I call express scripts who handle the drug/prescription part, but they can't tell me what they cover as I need to give them a 'contract' number. I call UHC and they can't give me a contract number unless we sign up with them. Told UHC this seems kind of stupid to have to enroll in order to find out what drugs are covered but got nowhere with them. Does anyone have or know a contract number for the Management UHC PPO option? I've got a couple of drugs with a high retail rate and want to verify that these are covered and at what price. Thanks in advance!
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