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I usually like to write about things I know about, but today isn’t one of those days. I am a moron when it comes to insurance, and I really don’t care to learn more about it. But, in order to get by in life without major headaches, we really do need to have a basic knowledge of insurance. Otherwise, you may get into a mess just like the one I am in right now.
Since 2014, I’ve had Medicare for my insurance because I am on disability for complex spinal problems. I usually buy additional Part D coverage for my prescriptions. But last year, I had particularly high medical bills, so I looked for secondary coverage to help cover expenses this year. I looked up plans available in my area, and during my research, I came across the AARP Medicare Complete HMO.
This plan sounded great! For just $89 per month, there are no co-pays for visits to your primary care physician and $25 co-pays for visits to specialist. In addition this plan has some dental and hearing coverage which I need. Prescription coverage was good for me too as it covered most of my medications. I was so happy when I signed up and breathed a sigh of relief thinking that my coverage was very much improved.
That feeling of confidence quickly faded into nothingness this week. I have had problems with my right knee for years, but this past weekend, I injured it somehow which led to searing pain in the front of my kneecap. I was barely able to walk. Stairs were particularly hard – I had to take them one stair at a time without bending my hurt knee. A day after the injury, I was unable to fully straighten my knee, and any attempt to bend it resulted in severe pain. I put ice on it and rested for about 1 1/2 days, and the symptoms improved, but the pain never fully went away.
This week, I made an appointment to see an orthopedic surgeon, Dr. Hosick. I had seen him several times in the past about my hip and knee. He had even x-rayed my knee previously and determined that I had chondromalacia in my right knee. Yesterday, I went to his office only to find out that since I was now in a HMO, I had to have a referral before I could see him. Uugghh.
This morning, I had an appointment to see my primary care doctor, Dr. Baker. When I explained to her that I needed a referral, she looked confused. “But I thought you were on Medicare,” she said. I replied, “Yes, but I got additional insurance this year. It’s a HMO, and I guess I now need referrals to see specialists.” She looked confused and then told me that her office may not accept this new insurance. I was stunned. She left to check it out and came back without any further information. The billing manager for the office wasn’t there today, and she really couldn’t tell me if they would accept the new insurance or not, and she wasn’t sure if she could give the referral.
I went straight home, really angry and irritated by what I had just learned about this new insurance. Honestly, I have no idea how all this works. I don’t know all the specifics of how HMOs are run. I called United Healthcare and told the young lady on the other end of the phone that I was confused and irritated that I had been to two doctors, both of which could not treat my knee because of insurance issues. She explained that I still have Medicare, but it’s now all under United Healthcare. I’m still not exactly sure how it all works, but I did learn that I can’t go to any specialists without a referral. Everything has to go through a primary care doctor when insurance is a HMO.
At one point, she offered to give me a one-time referral while everything was being looked at regarding my primary care doctor. Well, it turns out that Dr. Hosick isn’t a preferred provider, so United Healthcare could not give a referral to that doctor. OK, so now my patience was running quite thin. Then I asked her to check and see if my spinal surgeon, Dr. Kalantar, was a preferred provider. This was of utmost importance to me as I had absolutely no intention of leaving him. After two failed spinal fusions, Dr. Kalantar was able to successfully fuse my spine in 2012. He had been my trusted spinal doctor since that time, and I will not go to anyone else.
Well, it turns out that Dr. Kalantar wasn’t a preferred provider either!! At that point, she said that one of the options was to discontinue this AARP plan and go back to original Medicare. I was confused…I thought we could only change plans during the open season (Oct – Dec). She said that I could still change it now, so I agreed with her, saying that if Dr. Kalantar wasn’t in the plan, I had to leave. I asked her if I could get a Part D plan for prescription coverage, and she said yes. She put me on hold, and I waited for quite a while, but when she came back on the phone, she apologized for the wait and told me that she was going to get another lady on the phone who would be able to discontinue the plan. The call was transferred, and I began the discussion with the second lady.
This second lady proceeded to tell me that she could not discontinue the plan over the phone. WTH?? The first lady told me otherwise. Now I was really getting mad. She gave me a list of ways that I could discontinue, and I chose to do it online. She told me to go to http://www.aarpmedicareplans.com and fill out the form on the site. After asking me a bunch of questions, she told me that I could get part D ONLY if they approve my request to discontinue the plan. WTH?? They might not approve it?? So, I asked the lady for clarification – “So, they may NOT approve my request to discontinue the plan?” Her answer was “yes”. At that point, I was so disgusted that I ended the call.
I went to http://www.aarpmedicareplans.com and did not find any form to discontinue the plan. I decided to send an e-mail that detailed why I was so disgusted with United Healthcare and this AARP plan. They have since sent a notice to me that a case had been opened.
This plan is awful. If I stay with this plan, I would basically have to start over. All the doctors that I have been going to for years and who know all the details of my health over the past ten years or so are not included in this HMO plan – ALL of them!! I would have to start over with all new doctors. In addition, the first spine doctor that I had screwed up my back. It wasn’t until I went to Dr. Kalantar that my spine was finally stabilized. I am NOT willing to go to just any doctor….some doctor that some HMO says I can go to….to treat my complex spinal issues!!
Beware of the AARP Medicare Complete HMO plan. It’s one thing if just ONE of my doctors wasn’t in the plan….but NONE of them are in the plan!! This should be a BIG RED FLAG to all those looking for good health coverage through AARP. Shame on you, AARP, for promoting this insurance plan!!
Update: I received an e-mail saying that they are forwarding my complaint to the Appeals and Grievance Department and that they would get back to me in 30 days. 30 DAYS!!! What about now? I have this knee pain and need to see my orthopedic doctor now!! But God forbid that they do their job and address this now….no, go on ahead and take 30 days…that’s no problem at all (obvious sarcasm). By the time they finish pushing around all the papers, it will probably be open season again. Pathetic!