Recently my health plan went from Medicare with a BlueCross Blueshield backup to a Medicare Advantage plan. Ive noticed no difference in coverage except I dont show my medicare card anymore just the BCBS. I used to recieve payment notifications from both medicare and BCBS. Now I just recieve them from BCBS. Ive always read them looking for provider fraud. Ive noticed a really big change in billing. For the first quarter of this year my new Healthplan was billed over 75,000 for my both my wife and I health care. The plan payed a little over 11,000. That billing included a carpal tunnel surgery on my wife and a 9 day hospital stay for me in february.
I found what the healthplan payed considering to be extremely low, considering what medicare used to pay. Along with these low payments, Im being billed excessively from the providers, which is against the law. I pay a copay only, if you are a contracted part of my healthplan thats all you get over and above what the insurance pays. Their fight is with them for any payment other than my small copay. Ive had to contact my insurer 4 times to negate bills sent to me by providers. One was from the local ambulance, they charged 1400 for ambulance ride and got paid 834.00 they wanted me to pay them 460.00 I refused called the insurer on a 3 way call they told them I am responsible for nothing and I am not to be billed for it.
I had the last colonoscopy of my life <total 3> they sent the results to a North Carolina lab which billed me over 200 over the healthplan payment. I called them trying to get it resolved and a billing person told me in a very rude way that I owe it and if I dont pay it within a prescribed amount of time it will go to collections. Again I called the insurer and got it thrown out.
The point is its become a partnership between myself and my insurer instead of me and the provider. It used to be the provider would assist with getting medicare stuff approved. Its all reversed. I dont see how it all can continue like this.