A few years ago the Republicans got the great idea to open up Medicare to private insurers. It's part of their backdoor plan to get rid of Medicare entirely.
In essence, if you have Medicare you can get a "Medicare Advantage" plan that is supposed to be more cost effective and better for those in lower income brackets. Sounds like a great plan and after a lot of red tape over transplant drugs I was told they were covered and I wouldn't have to worry about the "doughnut hole" with this plan. Since all my doctors were part of Health Net Amber I joined.
I'd been pretty happy with it for several months. Michael kept asking how they made money. After all, they're a profit making business. I really couldn't answer. All I knew was that I didn't have to pay co-pays for my doctors and my meds were affordable. Who cares about the rest?
Then, slowly but surely it happened. With each visit to the doctor the "covered amount" dropped. After a few months the "covered amounts" were beginning to be less than 25% of the cost of the visit. The bills for the "balance" have begun to arrive.
Today I got an explanation of benefits from Health Net for a visit to my Hepatologist for a transplant checkup. The charge for the visit was $181, which is an outrageous amount since it didn't even involved a physical checkup, just going over lab tests and chatting for less than 15 minutes. Oh, and writing a new prescription for my blood pressure medication. Anyway, the "covered" amount from Health Net was $87. So, I will get billed for the difference as I was for the last visit which, amazingly, was paid at a higher rate.
The same has been true of my GP. I've had two visits with him since changing plans and each time the "covered amount" has dropped. I'm concerned at this point that I will need to cancel my annual physical next month out of fear that Health Net will not cover it at all. At least with regular Medicare I would know that it would cover 80% regardless.
So, now I know how they make money. They sucker you in with promises that they pay "at least what Medicare does" then once they have you all signed up they do nicely for a few months. That makes sure that you cannot have second thoughts and are tied into them for at least a year. Then, slowly they drop your "covered services" until they are paying FAR LESS than Medicare does for normal services - leaving you with the bill.
After getting the EOB today, I'm waiting for that bill for almost $100 to show up from my hepatologist. It'll be a bill I can't pay. At least with Medicare my part would only have been about $36. Welcome to the world of GOP and Blue Dog Democrat handouts to their masters in the insurance industry. Hope the CEO of Health Net will be able to make that campaign contribution to Baucus, McCain, Kyl, and Gabby Giffords.
Isn't it time we took out the for-profit middleman in all this? Come on people, we need to dismantle private insurance in this country completely.