Hosptial San Antonio- Advantage Ins

[lakeside7]

I had an interesting experience this pm. 

During the open enrollment period for my US supplementary insurance, I opted to switch carriers from a AETNA which only gave me 60 days emergency coverage outside the USA, to a HUMMANA GOLD PLUS HMO which my wife has and gives her unlimited time outside the USA. She is also "registered" at the HSA and has received treatment there with no problems.

Today when I tried to present my new information, the administrator  said the hospital was not taking any more Hummana Insurance because of some problem about re  imbursements . She was vague as to who decided to terminate the relationship, but said my wife should have received an email giving her this information!

I wonder if this is the tip of the iceberg and others will follow?

[RickS]

Right, like Humana got wise and/or found out that she or someone was not just 'traveling' but living in Mexico.  

 

 

[Bisbee Gal]

Raise your hand if you're surprised. 

[lakeside7]

2 minutes ago, RickS said:

Right, like Humana got wise and/or found out that she or someone was not just 'traveling' but living in Mexico.  

 

 

I am not sure you understand my post...SAH is not taking Hummana insurance period. Wife's coverage was legit and she happened to be at Lakeside for only 3 months

The devil is in the detail that the administrator failed to explain to me.... obviously the relationship has soured. The $64K question is why. Please no smart remarks....has anyone else had this experience????

[bmh]

They are not taking AXA either and AXA is a Mexican insurrance so what is new?

[lakeside7]

2 hours ago, bmh said:

They are not taking AXA either and AXA is a Mexican insurrance so what is new?

You are talking apples and oranges...Please. Let's stay with Gringos that have a USA Advantage  HMO, and may have enrolled with SAH.... not a Mexican insurance plan

[RickS]

Well, yes, I understand that SAH is not taking Humana period.... any more. But they did in the past and you changed to them so you could be covered for 'unlimited time' also instead of the 60 days Aetna was offering. And yes, we've had this conversation and yes, I understand that your wife has been served medically at SAH.  BUT.... Humana Gold Plus HMO is a Medicare Advantage policy.  Medicare Advantage HMO policies BY DEFINITION serve a particular area ONLY, using providers of their choice in that area. Advantage policies do offer coverage FOR EMERGENCIES in the USA if a person is away from home TRAVELING. If it's not an emergency one must wait until they return from their travels and seek medical service at the office of their local PCP. Non emergency situations are not covered by this provision.

Medicare Advantage policies can also cover one while traveling abroad. BUT the coverage is still ONLY for emergencies... and in some/most cases it must be for inpatient care only...  your really have a problem that must be attended to!

I understand that you and your wife are not/have not been 'just traveling' at Lakeside but rather either have a home here and/or are snowbirds.  Even if it is for 3 months. This does NOT meet the litmus test of 'traveling'. I, of course, have no way of knowing if your wife's past visits to SAH were emergencies or not and whether or not she was an in-patient client and I surely don't know how SAH went about billing Humana for any services she might have gotten there. BUT I do know that Medicare Advantage policies do not provide, in Mexico (or anywhere for that matter) routine medical non-emergency services for people mainly living outside of their provider area. 

The real $64k question is 'how did SAH go about billing Humana Medicare Advantage in the past for any non-emergency/ non-impatient medical services' that were performed in Mexico'?  How did they 'code' the service? They won't/didn't tell you why all of a sudden they can't take your Humana Medicare Advantage policies.  I'll BET the relationship soured as Humana finally got around to understanding that the services that SAH were billing them for did NOT meet the requirements of Medicare nor their Advantage policy.

P.S.  You say that your wife's coverage was 'legit'.  Can you explain how you know that?  If it is because 'SAH took her insurance and didn't charge her but obviously billed Humana'.... that's no proof.  The real proof would be a written statement from her Humana Gold HMO Medicare Advantage administrators  that they would be glad to cover any and all services for your wife in Mexico even if she was not really 'just traveling' but actually lived there continuously for 3 or more months at a whack.

P.P.S.   'Unlimited Time Coverage' does NOT mean that one is automatically covered for 365 days while away. That provision is for folks whose work has them traveling within the US a great deal of the time and are thus more likely to be away from their home HMO coverage area if they happen to have.... an emergency.