Clover in Atlantic County NJ

[Peter R]

Heard that CLOVER crushed Aetna in the MAPD arena last AEP. Anyone in NJ working with them?

 

[craig_ritter]

Heard that CLOVER crushed Aetna in the MAPD arena last AEP. Anyone in NJ working with them?

Peter,

Ritter is administering the external broker distribution channel for Clover in NJ (app processing, commission payment, onboarding, etc.). There are a number of great local agencies working with us on this as well. Ritter works primarily the admin piece. They are very strong in Atlantic, there are only 6 companies there offering 9 plans and 2 of these are DSNP. Clover has been there since 1/16 and the acquired about 40% market share in the traditional MA space in Atlantic.

PM if you'd like to talk more!

Craig

 

[rhcbp]

Craig:

Has there been any problems with docs not accepting the PPO plan? I was very skeptical, about Clover, but I have not heard any horror stories. Not only in Atlantic in the rest of the State as well.

 

[j10]

Craig:

Has there been any problems with docs not accepting the PPO plan? I was very skeptical, about Clover, but I have not heard any horror stories. Not only in Atlantic in the rest of the State as well.

Here's one of their posts from a few months ago:

Hi everyone!

Here at Clover, we know how tough it can be sometimes to get the healthcare information you need. Thanks for having this dialogue so that we can have the opportunity to offer you more clarification.

The Clover speaker was correct in saying Medicare doctors must accept Medicare PPOs, but a bit more context may help clarify. According to the Center for Medicare & Medicaid Services, if you’re a member enlisted in a Medicare PPO, Medicare doctors are obligated to offer you services unless the doctor is not accepting new patients and you are a new patient. So, the speaker was right in saying Medicare doctors must accept PPOs—so long as the plan is a Medicare PPO, like all Clover plans are, and the doctor is still accepting new patients, or you were an existing Medicare patient.

We would also like to take this opportunity to confirm that Clover is a THREE STAR plan. This current rating is based on 2014 data when we were a small plan with few members. Since then, we have made fantastic strides with our technology platform around care management and provider alignment, and are happy to speak directly with anyone about it - as we are very proud of the work we are doing daily around quality care and service and know this is a very important aspect of our Medicare Advantage offerings.

We hope this response helps to clarify some questions for you. If you have any more questions, or would like additional information about Clover plans, please reach out to us at (888) 657-1207, 8am – 8pm, EST.

Sincerely,
Your Friends at Clover