Medicare Advantage plans

[49994]

https://www.kvrr.com/2024/09/10/essentia-health-refusing-some-medicare-advantage-insurance-plans/

An interesting read.....Some plans have started to require prior authorization for PT/OT/DC care this month as well. Twice the denial rate for treatment when compared to other insurance companies. Hopefully people see this and make better decisions for their healthcare.

 

[701FishSlayer]

I'm currently at war with my insurance company trying to get an mri. I have a herniated disc that's become so bad over the years I can't hardly walk or stand on it. Need it fixed. Insurance company said no mri cuz its not medically necessary and that I just need to do 6 weeks of physical therapy first.

 

[Silver]

701,
Which insurance company do you have?

 

[1bigfokker]

I'm currently at war with my insurance company trying to get an mri. I have a herniated disc that's become so bad over the years I can't hardly walk or stand on it. Need it fixed. Insurance company said no mri cuz its not medically necessary and that I just need to do 6 weeks of physical therapy first.

Go see Brittany Benson at essentia in Fargo spine program at the hospital. She got my back and neck squared away.

 

[701FishSlayer]

701,
Which insurance company do you have?

Just regular insurance. United Healthcare I think.

 

[Obi-Wan]

I'm currently at war with my insurance company trying to get an mri. I have a herniated disc that's become so bad over the years I can't hardly walk or stand on it. Need it fixed. Insurance company said no mri cuz its not medically necessary and that I just need to do 6 weeks of physical therapy first.

I had to do 3 chiropractor session before they would approve an MRI for a pinched nerve in my neck in January. Sanford simplicity insurance.

 

[701FishSlayer]

Ya insurance is something else. I basically haven't been able to walk since the state fair. Then they tell me to get fucked when I'm looking for help. Trapped in my house for over a month now just waiting. Physical therapy next week for slipping vertebrates.

 

[Pheasant 54]

All I know is the person we deal with on our medicare stuff told us to steer clear of Part C advantage plans, If health care facilities all over the US are starting to not accept them why would you go that route

 

[701FishSlayer]

I herniated a disk in 2007 that has needed repair since. Just got worse and worse over the years. I've been too busy having other surgeries to get it fixed. Insanity. Went for an xray cuz I thought we should fix it now. Xray comes back and says I have a couple vertebrates slipping. Insurance company denies mri and says to do physical therapy first. Im really hoping it works i dont wanna have to fuse some vertebrates but...In between then and now I took a ride to the emergency room cuz it got so bad. Got em to do a CT scan that shows a herniated disc pinching my spinal canal shut. All too familiar I've already had a lumbar laminectomy surgery in 2011 to get me walking again. We've come full circle.

 

[Wall-eyes]

Ya insurance is something else. I basically haven't been able to walk since the state fair. Then they tell me to get fucked when I'm looking for help. Trapped in my house for over a month now just waiting. Physical therapy next week for slipping vertebrates.

I know how you feel I have neuropathy really bad finally lowered my standards and got handicap card for vehicles, Ya I know shoot me head not proud by no means the way it is going be in fucking wheel chair way to soon then I will be like that guy on Forest Gump show is life not grand. I have fought all kinds hospitals and damage they caused me. We can all write book on troubles with damn dr and hospitals took 6 years of back pain to tell me I have one kidney half full of cancer MF. Enough said I wish you all the luck and better health sir.

 

[tikkalover]

Yep, insurance companies want to try the "cheap" way to fix things first.

Cortisone shots first then PT.

After you spend all that time and money, most of the time you end up with surgery anyway.

Would of been cheaper to just do the surgery in the first place.

 

[wslayer]

Had to jump all the hoops. Required 2 months PT, had to have primary Dr. And Therapist sign off that things wouldn't get better with treatments. Then and only then was MRI for surgery allowed.

This was not Medicare Advantage plan.

 

[3Roosters]

Why choose Medicare Advantage in the first place???

 

[Ericb]

I sold Medicare plans for many years. Still do at a minimal extent. I was a employee of both the companies mentioned in the article. I would never do business with either again. There are quality Medicare advantage companies. Cost containment is how the plans are structured to give you better benefits for the money. Some companies take this to far and that is what your seeing. The issues aren't just with advantage plans that's just where they are noticed the most due to our limit in options and higher frequency of use.

 

[Davey Crockett]

I'm currently at war with my insurance company trying to get an mri. I have a herniated disc that's become so bad over the years I can't hardly walk or stand on it. Need it fixed. Insurance company said no mri cuz its not medically necessary and that I just need to do 6 weeks of physical therapy first.

I went through the same thing with insurance, it's the normal chain of commands. I eventually got MRIs but who ever reads them must not be able so see nerve compression because the reports said some wear but otherwise remarkable or some jazz like that.

PT made it worse and I was busy at work so I blew it off for a few more years until I couldn't take it anymore.

Bought an inversion table and tried a couple minutes at a time and instant relief for a few minutes. After a few sessions I increased the hang time with better results so I hung for a long time one day , felt good for a while but could barely move the next day.
Went back to Dr. another MRI report was same results and was told to try PT again. No way I was going to more PT so I requested chiropractor instead. Chiropractor asked a few questions , looked at the MRIs and took one X ray and told me there is nothing he can do for my lower back so went to specialist and more MRI and scheduled surgery during the winter.

I kept working and one day I felt something pop in lower back and the pain went away to almost nothing and surgeon had requested another MRI and I was ready to cancel surgery but went in and then get a phone call telling me I need surgery right away. Disk had ruptured so ended up with L4-5 fusion. Thinking back , one thing I would do different is keep going back to the DR. more often for quicker results. If the wheel doesn't keep squeaking nobody will fix it.



Good luck in your journey.

 

[701FishSlayer]

I went through the same thing with insurance, it's the normal chain of commands. I eventually got MRIs but who ever reads them must not be able so see nerve compression because the reports said some wear but otherwise remarkable or some jazz like that.

PT made it worse and I was busy at work so I blew it off for a few more years until I couldn't take it anymore.

Bought an inversion table and tried a couple minutes at a time and instant relief for a few minutes. After a few sessions I increased the hang time with better results so I hung for a long time one day , felt good for a while but could barely move the next day.
Went back to Dr. another MRI report was same results and was told to try PT again. No way I was going to more PT so I requested chiropractor instead. Chiropractor asked a few questions , looked at the MRIs and took one X ray and told me there is nothing he can do for my lower back so went to specialist and more MRI and scheduled surgery during the winter.

I kept working and one day I felt something pop in lower back and the pain went away to almost nothing and surgeon had requested another MRI and I was ready to cancel surgery but went in and then get a phone call telling me I need surgery right away. Disk had ruptured so ended up with L4-5 fusion. Thinking back , one thing I would do different is keep going back to the DR. more often for quicker results. If the wheel doesn't keep squeaking nobody will fix it.



Good luck in your journey.

I'm afraid of the fusion deal. They tried to do that to me 12 years ago. I got a second opinion and they did a complete different surgery the first time. Prolly won't avoid it this time tho. I guess whatever at this point I'm just ready to be fixed. Can't even go in a boat anymore.