Accepting Medicare = Accepting Medigap

Mar 22, 2016

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  1. Klutch
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    Klutch Super Genius

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    i'm aware that if a doctor accepts Medicare, he must accept all Medicare Supplements; I remember reading this in one of Medicare's books, does anyone know where I can find a copy of this? It would be handy to have when a prospect worries "but what if my doctor doesn't take XYZ medigap policy?"
     
    Klutch, Mar 22, 2016
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  2. midwestbroker
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    midwestbroker Guru

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    The closest thing I could find is on page 20 in the Choosing a Medigap Policy book:

    In most Medigap policies, when you sign the Medigap insurance contract
    you agree to have the Medigap insurance company get your Medicare
    Part B claim information directly from Medicare, and then they pay the
    doctor directly whatever amount is owed under your policy. Some Medigap
    insurance companies also provide this service for Medicare Part A claims.

    If your Medigap insurance company doesn’t provide this service, ask your
    doctors if they participate in Medicare. Participating providers have signed
    an arrangement to accept assignment for all Medicare-covered services.
    If your doctor participates, the Medigap insurance company is required to
    pay the doctor directly if you request. If your doctor doesn't participate but
    still accepts Medicare, you may be asked to pay the coinsurance amount at
    the time of service. Your Medigap insurance company will pay you directly
    according to policy limits.


    So in the rare occasion there is a provider that does not file with the Medigap carrier, the client can get paid direct from the carrier.
     
  3. somarco
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    somarco GA Medicare Expert

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    You can try a Google search. Could be in Medicare and You or Choosing a Medigap Policy.

    But if you are encountering this objection you have a credibility issue. You have not established a level of trust with the person you are talking to.
     
    somarco, Mar 22, 2016
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  4. Klutch
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    Klutch Super Genius

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    If a doctor's being difficult and doesn't want to file the Medigap insurance, how does the client show the insurance company "I had XYZ service done, reimburse me" ? Will Medicare notify them automatically?

    Yes, you're correct. What are some ways you personally build credibility with the client?
     
    Klutch, Mar 22, 2016
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  5. vic120
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    vic120 Guru

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    I find with this many times it is the confidence.You need to be Very confident in what you are saying on this.

    Seniors are afraid of change.

    1 of the things I say is with medicare advantage these plans replace medicare and that is the reason they are Identified by HMO or PPO type network because the INS co is the insurer and makes the decisions. That is also why they are subsidized by the govt and the cost is so much less

    with medicare supplement medicare is the primary and the supplement just pays the left over. There is no additional renegotiated rates. There is no dept that decides if a charge is acceptable to the Ins co

    It is much more simple medicare pays there part and according fed Law the Ins co pays the left over

    Otherwise they would not be allowed to sell supplement. They would be shut down

    For this reason ever doc or hosp that accepts medicare must accept the Is regardless of who the company is because they all pay the same and pay quickly

    Only one time I lost a client because the girl at the doc said she never heard of new era and that she would not be able to come there with this ins.

    That was the only time the shame of it was it was mis info and the woman stayed mutual of omaha for $130 more per month
     
    vic120, Mar 22, 2016
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  6. somarco
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    somarco GA Medicare Expert

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    Time for Medicare 101.

    Providers don't file Medigap claims. They file with Medicare, claim is adjudicated, approved (or not) then sent to Medigap carrier via crossover.

    I suppose there may be a few Medigap carriers that don't participate in crossover but I am not aware of any.

    Those that do participate in crossover will not accept claims filed direct by patient or provider.

    Credibility starts with rapport.

    Rapport starts with a conversation.

    Learn to ask questions instead of telling your story, or, God forbid, reciting a canned sales pitch.

    Those you are talking with can smell a fake a mile away. These folks have been around the block so many times they will rarely get sucked in.

    I have been in the health insurance business a long time but only in Mcare a little over 4 years. When I transitioned to Mcare I could barely spell it. I lost business that today I would write.

    I lost it because the people I was talking to knew I couldn't answer their questions. They knew because I told them I wasn't sure and would have to get back to them.

    I lost a few, but also wrote enough because they could tell I was honest and really would get the right answer rather than BS'ing my way through.

    It may take you a few weeks or even a few months before you have enough confidence to move forward 99% of the time. Until then just accept the fact you won't sell every one but you will get better as you go.
     
    somarco, Mar 22, 2016
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  7. TwoCents
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    I was scrolling through wondering when someone would bring up the crossover. Took long enough!
     
    TwoCents, Mar 22, 2016
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  8. thomasm
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    thomasm Guru

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    You must not do very much telemarketing because that concern comes up about 60 times a day for me.

    The other one is "yeah, but they pay all the bills..."

    Some people, no matter how many times I try to explain how crossover billing works, they still don't get it.

    Whenever I hear someone say their clinic only accepts BCBS or doesn't take X carrier, I explain that is either ifp/group health or MA. Never original Medicare.

    Anyone know any good analogies that will make this more clear. I've used the two gas stations offering the same gas but charging different prices analogy.

    What are some other good ones?
     
    thomasm, Mar 22, 2016
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  9. Chazm
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    Chazm Guru

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    Buying a car. Same exact brand new car from a dealership in the next town. Charging less
     
    Chazm, Mar 22, 2016
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  10. GreenSky
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    Georgia and Alabama. Except for Atlanta the same states.

    Rick
     
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