AboutJohn Pedit Expertise Am an expert on Medicare, Medicare HMOs, and Medicare supplemental insurance. Also have extensive knowledge of Medicare especially in Mich. Have knowledge of COBRA and the Portability Act
Experience
Past/Present clients Council about 300 persons yearly and do many presentations on Medicare
Question My parents currently have MedicareComplete H0543 - 084, an HMO plan. My Mom was diagnosed with gall bladder cancer and we want to go to a large cancer center out of the network. Time is of the essence and we're waiting for the insurance company to approve the out of network referral for a consultation from her PCP. I've already taken her to this out of network provider and paid for a consultation. I'm expecting resistance from the insurance plan and I'm wondering what other options might be available.
What about waiting until 11/15 to switch back to original medicare?
If we switch back to original medicare can we still get medigap insurance now that she has cancer?
Or will we have to pay the 20% that medicare doesn't cover?
If you change back to original medicare on 11/15 does it take affect immediately?
Please help.
Answer hi Linda
The trouble with an HMO, you have to get permission to go out of network. Without that you have to pay. Regardless, you might try appealing a denial. You will find the instructions in the packet they had to furnish when you parents joined them. Lots of luck on that one.
Now the other matter. The open enrollment period for next year is indeed between 11-15-09 and the end of December.She can change from the HMO to another Advantage Plan or go back to original Medicare. All Medicare benefits are still covered and a new plan must be issuedwith a
start date of 1 January.
In a few days, she should receive a copy of MEDICARE AND YOU 2010. That will answer most of your questions. In the back of the manual is all the new plans in her area. In the center of the back cover is the number of the SHIP office closest to you. That is a Medicare trained group of counselors. Call them and make an appointment to have one of them do a search for the best options for the new year.
