Medicare Advantage

Here’s a ‘secret’: Carriers might know better than the healthcare providers who is in-network. This is especially the case if the exact person that you are talking to is not completely aware of the way that network participation works. What is the world does this mean?

Let me give you some examples.

A client presents a card, is told by the billing office that the healthcare provider doesn’t accept the carrier. First, we vet all providers to confirm whether or not your providers are in-network, and will inform you if a provider is not in-network. Second, the provider may not understand how Medicare works (yes, this happens, even now), that if the provider accepts the federal Medicare card, then the worst case is that the out-of-network cost is assigned to you. Third, certain providers intentionally leave themselves off the in-network list that you can find online. Fourth, the status of network participation may not be via that office. This is especially true if that provider is part of a hospital system, etc, because the actual billing can be via the system, and not the office. A similar situation can occur if the billing is handled via a third-party vendor.

These are all commonly-found situations.