An Open Letter To Insurance Executive Lurkers.....

[dandan]

work and build your business and then the companies kick your clients out of their plans. We are straight commission, every company meeting I go to brag how they treat their agents the best, how they care for their agents etc.

It you ask me, they are crooked!

 

[annon123]

Today, I talked to three of my Tricare for Life clients on MA Only PPO policies.

One is on dialysis. The other two have "normal" health conditions.

Asked all three: Any problems? Any issues? Any complaints?

All three (including dialysis lady): no, it's great! No issues.



Crazy, because I thought the MA restricted all of their medical care...

Someone should tell them.

Judging what happens for everyone based on what is happening for 3 people doesn't mean what is going on is representative for everyone. When there is only one standard of care for what is being done likely there will be little issue. With low enough kidney function you do dialysis. Other than a transplant there are no other choices. End of story. As a result there would be no denials put in a patient's way.

Treatments that are lower cost or a "standard" set of meds/treatments exist for many conditions and so those are approved no questions asked. There are some medical issues where that is not the case. That is where the debate begins and roadblocks are put in the way forcing some patients to take a route that their physician (and sometimes newly current "best practices") would not choose, forcing them to fail those before they can do the, often, more expensive one next. Or having it denied completely and having to appeal.

Research over and over documents the problems with denials for treatments, meds, etc. for patients on MAPs are higher for those than those with OM when it comes to a variety of diseases, treatments... If you read medical forums there are complaints over and over about what goes on in MAP's vs OM with approvals for covered treatments. The denials are higher with MAPs, the delays are longer... Patient care suffers.

 

[sshafran]

Judging what happens for everyone based on what is happening for 3 people doesn't mean what is going on is representative for everyone. When there is only one standard of care for what is being done likely there will be little issue. With low enough kidney function you do dialysis. Other than a transplant there are no other choices. End of story. As a result there would be no denials put in a patient's way.

Treatments that are lower cost or a "standard" set of meds/treatments exist for many conditions and so those are approved no questions asked. There are some medical issues where that is not the case. That is where the debate begins and roadblocks are put in the way forcing some patients to take a route that their physician (and sometimes newly current "best practices") would not choose, forcing them to fail those before they can do the, often, more expensive one next. Or having it denied completely and having to appeal.

Research over and over documents the problems with denials for treatments, meds, etc. for patients on MAPs are higher for those than those with OM when it comes to a variety of diseases, treatments... If you read medical forums there are complaints over and over about what goes on in MAP's vs OM with approvals for covered treatments. The denials are higher with MAPs, the delays are longer... Patient care suffers.

4th T4L in 2 days - reviewed - everything is "perfect" (her words, not mine) and she wouldn't change anything.

A few other reviews already done this morning - MAs - and man, someone needs to tell my clients that they have sub-standard care because they're just not getting it.

They're probably gaslighting me. We all know their plans are crap.

 

[sshafran]

4th T4L in 2 days - reviewed - everything is "perfect" (her words, not mine) and she wouldn't change anything.

A few other reviews already done this morning - MAs - and man, someone needs to tell my clients that they have sub-standard care because they're just not getting it.

They're probably gaslighting me. We all know their plans are crap.

While I was typing this, one of my clients (80 years old) who had Plan F from age 65 to age 79 called.

You see - during AEP 2023-24 I moved him to a MAPD, and he went off of Plan F. His wife stayed with traditional Medicare + Plan F.

He wants to set an appointment to get her switched from Plan F to MAPD.

These people are just gluttons for punishment. But on Saturday I'll move her from Plan F to MAPD.

 

[straightnochaser]

Today, I talked to three of my Tricare for Life clients on MA Only PPO policies.

One is on dialysis. The other two have "normal" health conditions.

Asked all three: Any problems? Any issues? Any complaints?

All three (including dialysis lady): no, it's great! No issues.



Crazy, because I thought the MA restricted all of their medical care...

Someone should tell them.

Yea but just wait until they get sick

 

[annon123]

Yea but just wait until they get sick

You are right - yes just wait... and, and except for a few areas of the country, when they want to go to top notch centers for top of the line care/second opinion and find out they can't and they fail medical underwriting so they can't switch - then they will be stuck. And even worse if they are in a MAP that has no out of network coverage - or even if it does but the MOOP is $12-14,000. For many that is unaffordable.

Then they will wish they had OM + G and could, for example, go out of state to MD Anderson Cancer Center for top notch care that the local university system doesn't know about yet (real example). Or go to the main Campus of the Cleveland Clinic, (OH) to have their surgery at the #1 cardiac department in the country rather than elsewhere that is unranked with higher than average mortality...

 

[sshafran]

You are right - yes just wait... and, and except for a few areas of the country, when they want to go to top notch centers for top of the line care/second opinion and find out they can't and they fail medical underwriting so they can't switch - then they will be stuck. And even worse if they are in a MAP that has no out of network coverage - or even if it does but the MOOP is $12-14,000. For many that is unaffordable.

Then they will wish they had OM + G and could, for example, go out of state to MD Anderson Cancer Center for top notch care that the local university system doesn't know about yet (real example). Or go to the main Campus of the Cleveland Clinic, (OH) to have their surgery at the #1 cardiac department in the country rather than elsewhere that is unranked with higher than average mortality...

I keep forgetting that the Cleveland Clinic only takes Medicare + G.

Need to re-watch those training videos from 2012 and brush up on my scare tactics!!

 

[sshafran]

I keep forgetting that the Cleveland Clinic only takes Medicare + G.

Need to re-watch those training videos from 2012 and brush up on my scare tactics!!

Basically, zero options:

Medicare Advantage Plans​

The federal government’s health insurance program for people ages 65 and older, and certain younger people with disabilities or kidney failure.

• Aetna Medicare Plan (Golden Choice).
• Aetna Medicare Plan (Golden Medicare Plan).
• Anthem BCBS Medicare Preferred.
• Anthem BCBS Medicare Select.
• Anthem BCBS Senior Advantage.
• AARP Medicare Advantage (Through UnitedHealthcare).
• AARP Medicare Advantage Choice (Through UnitedHealthcare).
• AARP Medicare Advantage Flex (Through UnitedHealthcare).
• AARP Medicare Advantage Patriot (Through UnitedHealthcare).
• AARP Medicare Advantage Optum Care (Through UnitedHealthcare).
• AvMed Health Plans (Choice | Circle) Medicare (through 12/31/2024).
• Buckeye Wellcare by Allwell Medicare Advantage HMO – Mercy Hospital only.
• CareSource Medicare Advantage.
• Cigna Preferred Medicare (HMO).
• Cigna True Choice Medicare (PPO).
• CommuniCare Advantage I-SNP/C-SNP.
• Devoted Health.
• Fida North Shore-LIJ Medicare – Cleveland Clinic Main Campus only.
• Humana Choice Medicare Advantage.
• Humana Cleveland Clinic Preferred.
• Humana Gold Choice.
• Humana Gold Plus.
• Medical Mutual of Ohio Medicare Advantage.
• Medicare A, B, C, and D.
• Medigold – Union Hospital Only.
• Molina Healthcare Medicare Advantage HMO.
• Paramount Elite.
• Perennial Advantage I-SNP/C-SNP.
• PrimeTime Health Plan.
• Provider Partners Health Plan (PPHP) I-SNP.
• SummaCare Medicare.
• The Health Plan SecureCare MDCR HMO.
• The Health Plan Secure Choice.
• United Healthcare Dual Complete SNP.
• United Healthcare Medicare Advantage.
• United Healthcare Medicare Complete.
• United Healthcare Medicare Complete Essential.
• United Healthcare Medicare Complete Choice.
• UPMC for Life.
• Valor Health Plan I-SNP.

Plan G or go away!

 

[straightnochaser]

You are right - yes just wait... and, and except for a few areas of the country, when they want to go to top notch centers for top of the line care/second opinion and find out they can't and they fail medical underwriting so they can't switch - then they will be stuck. And even worse if they are in a MAP that has no out of network coverage - or even if it does but the MOOP is $12-14,000. For many that is unaffordable.

Then they will wish they had OM + G and could, for example, go out of state to MD Anderson Cancer Center for top notch care that the local university system doesn't know about yet (real example). Or go to the main Campus of the Cleveland Clinic, (OH) to have their surgery at the #1 cardiac department in the country rather than elsewhere that is unranked with higher than average mortality...

Y'all just have that one scare tactic and repeat it ad nauseum it's pretty insane.

 

[rousemark]

While I was typing this, one of my clients (80 years old) who had Plan F from age 65 to age 79 called.

You see - during AEP 2023-24 I moved him to a MAPD, and he went off of Plan F. His wife stayed with traditional Medicare + Plan F.

He wants to set an appointment to get her switched from Plan F to MAPD.

These people are just gluttons for punishment. But on Saturday I'll move her from Plan F to MAPD.

You can continue with this foolishness but just because you haven't had any clients that have had problems doesn't mean that there are not some that have had them. I only had an MA for 4 months and I experienced them. That is the reason I went back OM and a plan G. Unfortunately for most that encur problems it is too late for them to change back.