A dying agents warning ‼️

[somarco]

as the appeal process moves on, so does the cancer growth.

Talked to a lady a few years ago with spinal stenosis and a lot of pain. Orthhopod filed the PA 4x before the carrier approved the MRI.

Then they denied the surgery PA. Two or 3 more appeals and finally approved her for surgery.

All of this delayed treatment for 8 months.

Stenosis isn't life threatening but when it progresses to the point of needing surgery the patient really does not want to wait any longer and neither does the provider.

 

[Ron Van D]

I just talked with someone who had an appeal that went on and on. Her cancer grew to Stage 4 by time it was approved.

 

[somarco]

an appeal that went on and on. Her cancer grew to Stage 4 by time it was approved.

And there you go . . .

Wonder what agents say when their clients tell them about delayed/denied care?

Oh wait, so many agents never hear these complaints. Wonder why?

 

[Fisher]

If they bribe you to sell it and they bribe the client to enroll in it, is it really in the client's best interest?

I am MS/MA agnostic as far as my book goes, but this is a damn interesting take on the matter.

 

[MedicareWAA]

And there's your problem.

If I ever find myself needing a heart transplant, I'm going to ask my doctor to get me one that came from an insurance company underwriter or claims processor. At least I'll know it's never been used.

Meant for Ron. Do you have clients whose MA plan denied them a heart transplant? Have you ever met someone with MA who couldn't get a heart transplant? Have you ever read a credible story about a person with MA who wasn't allowed to get a heart transplant?

I hear you about MA plans coming with the potential for red tape. You're signing up for managed care. But your example, and ones like it, grossly exaggerate the pitfalls of MA.

 

[MedicareWAA]

And there you go . . .

Wonder what agents say when their clients tell them about delayed/denied care?

Oh wait, so many agents never hear these complaints. Wonder why?

Though very uncommon, I think yours is a much more honest example of a MA pitfall. It is by no means common, and appeals are expedited in these circumstances, but cutting through the red tape could be catastrophic in a fringe case. Emphasis on "could".

In the case of cancer PAs, it's not the normal treatment that's questioned. It's the unconventional stuff, but it's true that having OM would have made that treatment far easier to access.

No one is denying chemo or radiation.

DELAYED care that is appropriate and needed? That's a real risk that should be considered when choosing your coverage.

DENIED care that's actually appropriate and medically necessary? The risk of being told no is exaggerated. Just because you want it and OM would cover it does not mean you should have it.

 

[rmhaire]

Meant for Ron. Do you have clients whose MA plan denied them a heart transplant? Have you ever met someone with MA who couldn't get a heart transplant? Have you ever read a credible story about a person with MA who wasn't allowed to get a heart transplant?

I hear you about MA plans coming with the potential for red tape. You're signing up for managed care. But your example, and ones like it, grossly exaggerate the pitfalls of MA.

My post about the heart transplant was a joke. And I'm pretty sure everyone got that.

I don't have any clients that have had a transplant. Don't have any that have had a sex change either ... but the day ain't over is it.

Me and the gang have been hacking on each other for years now over MA and OM. I'm not going to change anyone's mind and neither will you. But it's still fun for shits and giggles.

The bigger problem is that it's about time for @kgmom219 to come back on here and tell us all to shut the hell up.

And the last thing I need today is Mom chewing on my ass.

 

[BALDELMO]

I want Karen Lynch chewing on mine.

 

[renee15]

That's not scary enough though so need to reword it. I have no idea why so many agents are against MA plans. I understand the ones who also do financial planning and P&C bc they don't want to bother with all the training. But the ones who call themselves Medicare agents make no sense to me, wouldn't you want to show the clients all their options? The only way to be 100% Med Sups is to try to scare people from taking anything else. Not sure why an agent would do that but to each their own I guess.

Aetna/CVS denies all PDP formulary exceptions-
So even if you have original Medicare/Med Supp
you still get familiar with the appeal process

 

[Yagents]

Aetna/CVS denies all PDP formulary exceptions-
So even if you have original Medicare/Med Supp
you still get familiar with the appeal process

Every health plan requires RX pre auth. Can't avoid that part, you can on most every other component of healthcare with OM