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Illinois BCBS Medicare "advantage" -- or disadvantage ?

Medicare in name only ! Only in-state.


BCBS Medicare "advantage" is a new insurance product from Blue Cross Blue Shield, in place since 2017. One would think that any "Medicare advantage" was a MEDICARE product, and just another way to administer Medicare benefits. Actually it is a private insurance entity resembling an HMO, that provides a subset of Medicare benefits to a subset of doctors. All in the state of Illinois. It does this by operating as an HMO does, and it pays only a small network of doctors. This means that if you go to someone who is not in the "Medicare advantage BCBS" network, you have no insurance. Obviously, if you are not in tip-top health, you should be very wary before you sign away your Medicare benefits. There does not seem to be any protection for seniors from these plans.

So lets compare - -Medicare covers all doctors in the US that take Medicare. Medicare advantage gives you insurance for their "network", generally only within the state. Think about it -- Blue Cross plans are state by state. Medicare Advantage plans have to be state by state as well. So you are out of luck if you go out of the state -- lets say you live in Indiana and want to see someone in Illinois. It isn't going to work.

There are other "flavors" of Medicare "advantage" -- basically these are HMO, POS, and PPO. These popular plans make money for the insurance companies by cutting Medicare benefits, and restricting choice. They restrict choices by having a "network". If one goes outside of one's network, then you have no health insurance at all. For example, if you get sick in another state, you may have no health insurance, even though you are theoretically on "Medicare", which is a national program. In our opinion, it is OK to "switch up" Medicare, and offer less of this, and more of that. It has been our experience though, that many of our poor senior patients think that they have "medicare", but actually they have an HMO plan.

In 2018, we have been getting 20 letters a day from BMA, stating that our practice is not "in network" with BCBS Medicare advantage, that they are taking all of the payments for our work back. In our view, this is fraud. They tell us that we have no contract with BCBS Medicare advantage, and thus they don't have to pay us for our work.

We now consider all BCBS Medicare advantage patients to be uninsured, with respect to our practice. They are self-pay. We have no contract with Illinois BCBS Medicare advantage. We no longer bill BCBS Medicare advantage, as although it has "Medicare" in the name, it doesn't provide Medicare benefits for our patients.




© Copyright April 19, 2018 , Timothy C. Hain, M.D. All rights reserved.
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