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

[rmhaire]

I'd be interested to know how many plans are in your county, and how many of them would give access to CC.

I'm sure you used the CC line with prospects...

What about Mayo?

 

[BALDELMO]

Yes, always on my BLT

 

[sshafran]

What about Mayo?

What about a podiatrist in New Mexico?

 

[annon123]

I'd be interested to know how many plans are in your county, and how many of them would give access to CC.

I'm sure you used the CC line with prospects...

The point is that OM is accepted at ALL top medical centers nationally without referral delays and potentially denials. There is not one MAP out there in any state with the same national in network list as OM and where referrals are not required. Some top centers only accept a couple of MAP's and some of them are in state only ones. Others accept far more. And, of course, if someone is lucky enough to live in a large city that has multiple top centers they have far less of an issue accessing top care than people in MS, LA, AR, etc. (the states with the worst health care in the nation) or some very rural counties where out of state decent care might be closer than in state decent care.

I don't try to influence their choices. I view my job as one to ask questions, help them determine their priorities, look at factors that might influence their choices (family history, current health issues, potential future ones, desire to travel and be gone for weeks or months at a time, etc.), I answer questions about specific medical facilities both in state and out of state that they ask about and I talk about networks in general. I make sure they understand the rules to change their choices over time.

Their income level matters too. If they have coming in more than 400% of the poverty line they have far more disposable income to cover unexpected costs or expected MOOP in and out of network (or if it even covers out of network) health costs than those below that (those at 200-400% of the poverty line have the most problems covering health care costs). Are they dual eligible? Do they qualify for medicare "lite"...

Then it is their choice whether or not an MAP (and then which one) will better meet their needs or whether OM will do so.

I fail to understand why you are so bent out of shape that I believe that in many cases OM + supp is a better choice for someone than a MAP. It's no skin off of your teeth and doesn't affect your income. What matters is that the client makes an informed choice about what is best for them both now and potentially in the future, understanding the pros and cons of that choice so they aren't blindsided later and can avoid, as much as possible, buyer's regret at a point in time where all options may or may not be open to them. Some clients are willing to take far more risks than others. Clients have different circumstances. Again it is their choice, not mine. Of course our job would be made much easier if we all had a magic wand or a time travel machine.

 

[sshafran]

The point is that OM is accepted at ALL top medical centers nationally without referral delays and potentially denials. There is not one MAP out there in any state with the same national in network list as OM and where referrals are not required. Some top centers only accept a couple of MAP's and some of them are in state only ones. Others accept far more. And, of course, if someone is lucky enough to live in a large city that has multiple top centers they have far less of an issue accessing top care than people in MS, LA, AR, etc. (the states with the worst health care in the nation) or some very rural counties where out of state decent care might be closer than in state decent care.

I don't try to influence their choices. I view my job as one to ask questions, help them determine their priorities, look at factors that might influence their choices (family history, current health issues, potential future ones, desire to travel and be gone for weeks or months at a time, etc.), I answer questions about specific medical facilities both in state and out of state that they ask about and I talk about networks in general. I make sure they understand the rules to change their choices over time.

Their income level matters too. If they have coming in more than 400% of the poverty line they have far more disposable income to cover unexpected costs or expected MOOP in and out of network (or if it even covers out of network) health costs than those below that (those at 200-400% of the poverty line have the most problems covering health care costs). Are they dual eligible? Do they qualify for medicare "lite"...

Then it is their choice whether or not an MAP (and then which one) will better meet their needs or whether OM will do so.

I fail to understand why you are so bent out of shape that I believe that in many cases OM + supp is a better choice for someone than a MAP. It's no skin off of your teeth and doesn't affect your income. What matters is that the client makes an informed choice about what is best for them both now and potentially in the future, understanding the pros and cons of that choice so they aren't blindsided later and can avoid, as much as possible, buyer's regret at a point in time where all options may or may not be open to them. Some clients are willing to take far more risks than others. Clients have different circumstances. Again it is their choice, not mine. Of course our job would be made much easier if we all had a magic wand or a time travel machine.

I didn't think this was too difficult.

You said two things.

1) Then they will wish they had OM + G and could...go to the main Campus of the Cleveland Clinic, (OH) to have their surgery at the #1 cardiac department in the country

and

2) the odds are high that the MAP's that CC accepts...would not be ones good in my state.

So, I'm simply trying to find out if what you are saying is true.

But you don't want us to look at your county to call you out on the poor information - it's OK - there are other things I can do with my time.

I made my point.

 

[annon123]

I didn't think this was too difficult.

You said two things.

I said far more than two things. You said you made your point and I made mine. What I do has no impact on you and vise versa.

The MAIN point I am making is that NETWORKS coupled with referrals and denials thus potential delays are what matters when you actually need to use your health care for something serious (and perhaps passing medical underwriting matters too depending on the medical issue and what the person wants - I am surprised, for example, that UHC doesn't ask about cancer). CC accepts more MAP's than MD Anderson (#1 cancer center). It looks like the Mayo (in MN, main campus) is pretty sparse too in what MAP's they accept - someone else had mentioned them. If you want a lot of choices nationwide MAP's are generally not it.

But it is not my choice what someone chooses. It is that of the client. There are people who swear by the Joint Commission D rated health system here. They'd never go out of state for anything. Actually, for that matter, I don't think some of them have ever even been out of state for any reason. And there are folks who want second opinions at a decent place because of that D rating and perhaps treatment for specific things there as well. Well for person #1 a MAP is probably fine presuming networks don't blow up in their face and they can handle the MOOP if they are going to hit the max. Person #2 probably not if they don't want to be limited by which highly rated set of places they can go to...

 

[somarco]

Because of clients I have checked a number of out of state medical facilities to see which ones are in network for MAP's sold here (a fair number here want to go out of state for cancer, other major illnesses because of how poor our state's health care is and the problems with what happens locally). Some work well and give a lot of choices, others not so much so. I just present the pros and cons and let them decide what they want to do. Most, but certainly not all, of those who want to travel for health care (and would fail medical underwriting) choose OM + G. I'd rather not write MAP's despite them paying more because of limits that could potentially come back to bite clients if they no longer were reasonably healthy and would then fail medical underwriting.

While the Cleveland Clinic accepts a lot of MAP's (although some are their state only versions), MD Anderson Cancer Center only accepts, last I knew, 2. And, of course, the risk is that what is in network might change for a particular MAP someone purchased. While clients could change the MAP they are in, they may not be able to change in time for timely treatment.

Accepted Insurance | Cleveland Clinic

Helping patients understand how insurance plans and healthcare benefits affect care access and costs.

my.clevelandclinic.org

Insurance Plans

If you are enrolled in a managed care plan (HMO, PPO or POS), your treatment at MD Anderson may be covered by insurance. See the list of accepted insurance plans here.

www.mdanderson.org

Medicare and Medicaid

Some Medicare and Medicaid plans are accepted by MD Anderson. View a full list of Medicare and Medicaid plans that can be used to cover the cost of your cancer treatment.

www.mdanderson.org

 

[sshafran]

I am surprised, for example, that UHC doesn't ask about cancer).

Hahaha

They ask about cancer. Where did you get the idea they didn't? Same place as the idea about the Cleveland clinic?

I feel bad for the misinformation you give your clients.

 

[annon123]

Hahaha

They ask about cancer. Where did you get the idea they didn't? Same place as the idea about the Cleveland clinic?

I feel bad for the misinformation you give your clients.

Misinformation? Unless it has changed since last week the medical underwriting form I just filled out for a client for AARP UHC did not include asking about cancer. Some do, but UHC is less picky than some of them are which is fortunate for clients with issues who want out of a MAP and want supp G or F (if they are eligible) due to expensive health problems. Hopefully before you tell clients they will fail medical underwriting and are stuck in a MAP or on the supplement they have and want to change what they have, you will actually look at the current forms.

You can continue to trash me all you want. Doing that says more about you than it says about me. If you need to do that to make yourself feel superior/better about yourself then feel free to continue. It doesn't affect my life/me.

 

[sshafran]

Misinformation? Unless it has changed since last week the medical underwriting form I just filled out for a client for AARP UHC did not include asking about cancer. Some do, but UHC is less picky than some of them are which is fortunate for clients with issues who want out of a MAP and want supp G or F (if they are eligible) due to expensive health problems. Hopefully before you tell clients they will fail medical underwriting and are stuck in a MAP or on the supplement they have and want to change what they have, you will actually look at the current forms.

You can continue to trash me all you want. Doing that says more about you than it says about me. If you need to do that to make yourself feel superior/better about yourself then feel free to continue. It doesn't affect my life/me.

It's possible it's not asked in your state. They ask in NC, OH (my 2 main states) and several others.

Which state are you in or what state did you take an app in where UHC did not ask about Cancer?