I need to know how

Posted: Fri Feb 27, 2009 11:21 pm Post Subject: I have Texas Health Spring

I have Texas Health Spring Insurance. I am not Happy with this Insurance. I have to wait to long for Doctor Referrals. I rather have Straight Medicare Insurance. How do I go about it.

Posted: Sat Feb 28, 2009 06:17 am Post Subject:

Well, you have opted for Medicare Advantage Plan. Haven't you read the policy document carefully while signing for the program? The advantage plan strictly states that you can't receive services from doctors apart from those in the network under normal circumstances. And, your primary care doctor would be responsible for referring you to a specialist if needed. You can't act on your free will under the Medicare Advantage Plan.

~Jeremy

Posted: Sat Feb 28, 2009 06:25 am Post Subject:

Hi Geneva, if you have decided to switch back to the original Medicare plan and drop Medicare Advantage, you need to inform the Medicare Advantage administrator about your decision. The Medicare benefits will begin from the first day of the following month.

Also, if you want to dis-enroll from Medicare Advantage and instead wish to join another program, you may simply have to enroll for that, Medicare Advantage benefits will automatically discontinue. However, please make an informed decision this time.

Regards,
Juanita

Posted: Sat Feb 28, 2009 06:36 am Post Subject:

Yeah, agree with Juanita…you should make an informed decision. Its important that you learn the pros and cons of every program that you wish to enroll with. I'd like to highlight few advantage of the Medicare Advantage Plan for the readers.

Medicare Advantage Plan is cheaper that the well known Medigap, which supplements the Medicare program.

With the Medicare Advantage you are not required to pay the deductibles and co-insurance attached with Medicare services. Further, you're released from dealing with the Medicare paper–works.

Medicare Advantage program covers services otherwise not covered under the traditional Medicare Program, like-coverage for eye-glasses & hearing aids, prescription drugs, dental coverage and so forth. Some of the plans also cover the traveling expenses to hospitals and pharmacies.

Therefore, weigh all the positives and negatives before taking the decision.

Hope you find the information useful.

Posted: Mon Aug 31, 2009 01:45 pm Post Subject: Texas Healthspring

Juanita,

I'm sure that you researched your insurance options, as did I. There are so many areas to cover and sometimes you don't know what you need until you actually need it.

I'm going through a similar problem with Texas Healthspring, right now. Some people don't understand until they're faced with a similar crisis and there's no one that cares.

My doctor referred me to a specialist reknown in pituitary tumors. Texas Healthspring has been giving me the run around with perscriptions, referrals, you name it. It doesn't matter to them about doctors referrals. What matters is the bottom line.

For the rest of you who automatically assumes that she did not research her advantage plan, don't get sick. Juanita is going through a new experience, one she didn't ask for, your compassion is about a cold as Texas Healthspring or any other big insurance company.

Posted: Sat Nov 27, 2010 02:10 pm Post Subject: Health Springs

I have fought my battles with this insurance company many times. Along with some primary doctors. Still having problems... after paying max out of pocket ($3200) for the year. Talked to 3 different representives and was told that my wifes next treatment (co payment) would not be required. She called and was told that she would have to pay for co-payments...cancer center called and was told she would have to make co-payments...is this not part of out of pocket expense...its seems to be covered by their booklet. Its for radiation treatment... Was told to have cancer center bill them for co-payment...it seems that they are not always on the same page with knowledge...will have to cross that bridge when we get there.

Posted: Sat Nov 27, 2010 11:54 pm Post Subject:

If you cannot get straight, solid answers from a Claims Representative, ask to speak to a Supervisor. If that person doesn't have the answer, ask to speak to their supervisor. If you get the proverbial run-around, then contact the Texas Department of Insurance. They can help.

http://www.tdi.state.tx.us/consumer/complfrm.html