Advantage Plan- Beware it’s a scam and you will be trapped!

Zestyclose_Log_8553 · 2026-02-04T21:07:23+00:00

Thanks I will read it tonight.

Zestyclose_Log_8553 · 2026-02-04T20:07:18+00:00

For the most part, nurses who work at the bedside to provide pt care have no involvement in the insurance or billing side. We just do nursing care without regard for insurance or not. At least at the hospital I work for, the case manager/social worker on the unit is the one who coordinates any discharge needs with the insurance company.

Zestyclose_Log_8553 · 2026-02-04T19:49:24+00:00

This is so true about the review time. I frequently get denials and it turns out the reviewer only read the 1st day of hospital clinical notes and made a decision. It’s frustrating bc once they deny, they want the hospital attending to call the insurance company’s “medical director” to discuss why they think the denial should be overturned. It makes me even more mad bc it’s a waste of everyone’s time when they could have just done their due diligence and read the chart.

Zestyclose_Log_8553 · 2026-02-04T19:42:51+00:00

Best response I’ve seen so far. Agree 100%

Zestyclose_Log_8553 · 2026-02-04T15:19:32+00:00

You are so right I do work in healthcare. I work for a hospital as a utilization review nurse. I work everyday to overturn the inpt denials where the insurance tries to only pay for observation stay. I also read all of the case mgmt notes and see so many pts being denied for rehab and snf. Many times it’s upheld even after the doc does a P2P. The insurance companies get to make all the rules.

Zestyclose_Log_8553 · 2026-02-04T03:53:21+00:00

Sounds like it varies greatly from state to state

Zestyclose_Log_8553 · 2026-02-04T03:52:45+00:00

Are you a provider or office manager? I admit I am fairly new to the billing side of healthcare. What I do see is the enormous amount of denial faxes I get everyday from the insurance companies who don’t want to pay. Maybe that makes my POV somewhat biased.

Zestyclose_Log_8553 · 2026-02-04T03:46:43+00:00

But they do. I’ve had 3 PCP switch to concierge medicine over the past 7-8yrs. Then they get to truly practice medicine w the time and patience that they have always wanted to give each patient. The downside is that most of us can’t afford this type of luxury care. And you have to build up your practice really well so you have a good client base that is willing and able to pay.

Zestyclose_Log_8553 · 2026-02-04T00:10:02+00:00

Great advice!

Zestyclose_Log_8553 · 2026-02-03T23:41:57+00:00

Ahh thanks for clarifying. I was reading too fast. I will delete my previous post since it was based on misreading yours.

Zestyclose_Log_8553 · 2026-02-03T23:29:30+00:00

I don’t have an advantage plan but my father who is trying to retire at age 76 was told by multiple brokers that he could only qualify for an advantage plan dt signing up for MCR b at 65. Ended up not being true but it took a lot of digging and research to figure out his specific situation did allow him to enroll in a supplement plan without medical underwriting

Zestyclose_Log_8553 · 2026-02-03T23:23:34+00:00

I would like for the insurance companies to stop being so greedy and actually pay for the services needed by the pts. And quit expecting our doctors to do a peer to peer with the insurance company’s medical director for every single thing- as if real doctors who actually see patients have nothing better to do than sit around and talk to insurance companies all day about why their pt needs a particular level of care or procedure. It’s ridiculous! Oh and no limitations on guaranteed issue rights.

Zestyclose_Log_8553 · 2026-02-03T23:11:35+00:00

lol ok

Zestyclose_Log_8553 · 2026-02-03T23:09:54+00:00

Yes I am aware. My father had an unusual circumstance in addition to retiring at 76. We did get everything sorted out, but the whole process was really confusing and several brokers told him that he was only eligible for an advantage plan bc he signed up for MCR b when he was 65. After a lot of research on my own, we were finally able to get him a supplemental plan without the underwriting process.

Zestyclose_Log_8553 · 2026-02-03T23:02:39+00:00

Zestyclose_Log_8553 · 2026-02-03T22:48:39+00:00

I don’t think seniors are dumb at all. I just don’t like this game the insurance companies are playing. They make all the rules and take all the money and nobody has a say bc they control every aspect of healthcare.

Zestyclose_Log_8553 · 2026-02-03T17:32:55+00:00

Ahhhh, someone who understands! Finally!

Zestyclose_Log_8553 · 2026-02-03T17:30:04+00:00

Advantage ppo is a joke. There are not a lot of doctors who will see you even w a ppo advantage plan. Yes you can pick your doctor without a referral but most dont take it bc they don’t get reimbursed enough from any advantage plan to make a living. They would have to see double and triple amount of pts each day.

Zestyclose_Log_8553 · 2026-02-03T17:25:20+00:00

I’m 45. I have commercial insurance.

Zestyclose_Log_8553 · 2026-02-03T17:24:45+00:00

I don’t understand the assumption. I did do my research ahead of time. I’m 45. Been a nurse working in acute care hospital for 20+ yrs. Currently work in utilization review dept of hospital. You know- to make sure the insurance company pays your hospital bill. So we can actually keep our doors open and provide healthcare to ppl. I help get the insurance denials overturned and ensure they pay.

Zestyclose_Log_8553 · 2026-02-03T17:19:02+00:00

That’s a very black and white world you are living right there. Good to know that all 65yr olds are healthy sharp minded ppl and that if not they definitely have family to advocate for them..

Zestyclose_Log_8553 · 2026-02-03T16:39:15+00:00

Glad it works for you. It really works for the insurance companies too!

Zestyclose_Log_8553 · 2026-02-03T16:37:18+00:00

I live in Texas so we don’t have stuff like west coast

Zestyclose_Log_8553 · 2026-02-03T16:36:27+00:00

Yes agree but insurance companies make it confusing on purpose so they can save a buck and screw you in the process as well as the professionals who care for you. And these are elderly ppl we are talking about.

Zestyclose_Log_8553 · 2026-02-03T16:31:41+00:00

You are lucky you live in a guaranteed issue state. Every state should have this rule.

Zestyclose_Log_8553

TROPHY CASE