As of January 1, Dr Di Biase is no longer accepting United Health Care insurance. Is this going to impact anybody else? Any recommendations for EPs in the NY area who still do?

Hi Calleydex,

I spoke with Dr DiBiase about this just a moment ago and he said that this was not his decision, but came from administrative at either Montefiore or United Health and effects only the UHC Medicare Advantage portion of United Healths overall Medicare suite of coverage options.

A letter that no doubt you reviewed on Jan 2nd notifying UHC Medicare Advantage holders offered the ability to switch to another plan or to just use the straight Medicare portion of coverage that all Medicare part A & B covered patients qualify for and then pay whatever extra charges might be incurred above and beyond what straight Medicare pays.

It might well be worth checking with Dr DiBiase’s office or Montefiore’s business office, to get a close estimate of what those extra charges might actually be for an AFIB ablation by Dr DiBiase above and beyond what your straight Medicare will pay for. For all in-patient procedures the added charge beyond what straight Medicare will pay can be a good d so less than the often quoted 20% added charges not covers by Medicare. That figure of 20% is most often hit with a lot of out patient work plus doctor office visits etc.

In any event, it’s worth checking to see if I’m your case the likely added increase in outcof pocket charges might be a lot more tolerable than you might have assumed and still be worth it to you to choose your original ablation EP ... which is an excellent choice ... in Dr DiBiase.

But again for other United Health insurance holders both private and Medicare based, this new restriction is only on the UHC Medicare Advantage plan portion among their various Medicare products offered by UHC.

Best wishes in sorting this all out, you also might consider making another visit to Dr DiBiase just to discuss what, if anything, he might be able to do in this matter as well.

Shannon

I am confused - I am 67 but not on Medicare yet - my health plan is Empire Plan (NY State teachers) through United Health Care. Should I call the Montefiore business office to sort this out?
Pam

Sounds like that would be the next best step Callydex. Dr DiBiase said that the restriction to the best of his knowledge only apples to the UHC Medicare Advantage plan portion of their overall Medicare coverage.

And be sure you are talking to a supervisor in the business department and reference the letter you received. Check with Dr DiBiases office too and perhaps get an appointment with him to discuss as well. From my long experience in helping usher folks through an expert ablation process, as well as my own extensive history of medical procedures, it is not unusual in situations like this where there is a limited change in insurance coverage for a given procedure where ... especially early on ... you might get a variety of interpretations and opinions of just what the new changes cover or not and what they really mean, and almost invariably only one of the opinions iscthe right one for your scenario. So keep exploring until you get a consensus opinion from various sources there at Montefiore.

Cheers!
Shannon



Edited 1 time(s). Last edit at 01/31/2018 01:38PM by Shannon.

I have the Empire Plan-New York State United Healthcare/BCBS

Swell,

McHale