What Insurance Companies (not Plans) Are Best

[Crichton]

My father and mother had an Aetna HMO supplement plan and Aetna's Appeal Process was so horrendous that it failed my father and caused his death. Aetna's appeals were handled by QIO/Livanta and an administrator for the first rehabilitation center told me Aetna was the worst when it came to appealing decisions.

I do not want to see my mother in the same position and slowly left to die because of a deaf eared and logic-deficient insurance company. Unfortunately, Mom (85) left things last minute because she was confused and intimidated by not knowing how to proceed. Enter myself, which is why I'm posting the question, "What Medigap Insurance Company is the best?"

My parents both liked Aetna's handling of prescriptions and medical costs. However, when the first rehab center failed to make my father stronger after six days of atrophy at a hospital which led to him falling, another hospital stay, a shortened rehab stay where he was rendered unable to walk and given a catheter (which gave him sepsis) and a bed sore, to a hospital stay for the sepsis, another round at a new rehab place which gave him a second bedsore after a more-shortened stay, to another hospital stay to give him a colostomy and have the bedsores cut out leaving a breakfast cereal-size hole below his tailbone, to be sent to yet another rehab -- all subacute -- which sent him back to the hospital and then to a hospice to die. Considering my father elected to be taken to the hospital after a slip from his bed without any injury (he wanted to go have his diabetic legs looked at), to have him dead less than six months later was and still is devastating

I don't want my mother or our family to go through this. Any and all suggestions would be deeply appreciated. Thank you.

 

[MBSC]

I'm sorry for your loss. The Aetna HMO would be a Medicare Advantage plan, not a supplement or Medigap.

Medicare supplement (Medigap) plans are labeled Plans A-N. Plan G is popular and covers all original Medicare cost sharing except the $198 (2020) Part B deductible. Your Mother would need to leave the Advantage plan and return to original Medicare during the annual open enrollment period (Oct. 15-Dec. 7 or Jan.1-March 31). However, she would need to pass medical underwriting to be issued a supplement (Medigap) plan unless she lives in the guaranteed issue states of NY or CT. She would also need to purchase a separate stand-alone Part D plan.

Original Medicare does not have the claim denial issues that for-profit Advantage plans have. Since original Medicare makes the coverage decisions, there is no "best" Medigap company. They all pay their portion in a timely manner.

This question is a little tricky to answer, as the best supplemental insurance with Medicare is really whichever plan has the lowest rate and the lowest rate increase history in your area.

After all, benefits are standardized so that the benefits for each plan letter are the same from company to company. Medicare supplement companies also pay your bills like clockwork because Medicare is the decision maker, so we never hear that any of them have slow-pay issues like the Medicare Advantage plans often do.

And if you are enrolling through Boomer Benefits, you never have to worry which insurance company has the best customer service because you won’t ever have to deal with them. We do all that for you. For free.

Reference: https://boomerbenefits.com/top-10-medicare-supplement-companies/

If you are asking which Medicare Advantage company is the best, they're all about as bad when it comes to denial of care because they are for-profit companies, unlike original Medicare. Switching from an HMO to a PPO will get your Mother access to more medical providers. If I had to enroll in an Advantage plan, I would use an independent insurance agent and make sure they have experience in getting denials overturned for their clients. Here is an exchange between two agents, Stephanie and Steve.

Stephanie: Several times I have had [Medicare Advantage] clients call saying the nurse said the plan wouldn’t approve an item or procedure. In every case it was one of two things: either there needed to be more documentation (and we were able to tell them exactly what was needed) or the nurse never bothered to try to get the PA because “they never cover it” but when they finally did so it did get covered. I have never seen a medically necessary procedure go uncovered. Yes, you do have to use network doctors, just like every other insurance currently available outside of original Medicare.

Steve: Stephanie, I know of two instances where the Advantage plan would not allow what most people would consider "medically necessary". Age 79 who lives alone was told by his Advantage plan he could not go to a Skilled Nursing Facility after spending a week in the hospital after triple bypass surgery. Age 81 with two brain bleeds was denied by his Advantage plan to go a SNF after his hospital stay.

Stephanie: Steve, not saying I don’t believe the client was told it wasn’t covered because mine have been told that. I’m saying once I got involved and made sure the request was directed correctly with correct supporting documents, I’ve never seen medically necessary treatment denied.

Reference: https://insurance-forums.com/commun...sadvantage-is-a-corporate-trap.100368/page-11