Clover Medicare PPO $0 in Network and Out

Discussion in 'Senior Insurance Forum' started by rhcbp, Sep 29, 2015.

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  1. rhcbp
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    rhcbp Expert

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    I just heard CMS has a different take on every Doctor must accept a PPO, is that true?

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    I just received the following letter from the President of Clover. Even though they told us that the doctors had to accept the PPO and that they would have wording on the backing of the card stating the same, it seems CMS has a different view. The new training is to confirm that we know doctors do not have to accept the PPO and that they will only cover in network and out of network services if they are medically necessary.

    Dear Broker,

    Thank you so much for your incredible efforts throughout this year’s Annual Enrollment Period. Your hard work has helped countless Medicare beneficiaries in your community get connected to coverage that really cares for them. The Clover team will live up to the great first impression you’ve given so many of our members with excellent customer service in 2016.

    There’s one more bit of training we’ll need you to quickly complete before we can provide you the commission you’ve earned throughout this Annual Enrollment Period—thank you in advance for getting it done. Again, it’s very brief, but it addresses important CMS regulations regarding Clover’s open-access network. We’d love nothing more than to be able to work with you again, but without finishing this training first, you won't be able to continue selling and marketing our plans:

    https://www.medicaresalessentinel.c...gramguid=1fbf66ea-4f46-40e6-84ea-8b91d872e667

    Truly, we cannot thank you enough for all that you’ve contributed to the Clover team this Annual Enrollment Period. If you have any questions or concerns at all, please don’t hesitate to contact our dedicated Broker Support Line at 855-979-2236 or email [email protected]. It would be an honor to be able to work with you again.

    Until we speak next, happy New Year!

    Sincerely,
    Alex McLean
    President of Clover
     
  2. Chazm
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    Chazm Guru

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    Soooo as we were all saying here, PPO's don't have access to every doctor as clover was claiming. Are they new to health insurance or something?
     
  3. rhcbp
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    rhcbp Expert

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    I believe the owners are new to Health Insurance, but not the management team. They sell to the very people who need the help the most, the poor and minorities. I would guess that 90% of their business was sold by guys setting up tables in front of supermarkets in the inner city. At least these people will be able to get out of the plan because they all have LIS. I just can not understand how CMS approved this plan in the first place. There whole sales pitch was that you can see any doctor that accepts Medicare, because they have to accept it. Now, after AEP is over, they have changed their tune. So during AEP they basically lied to the consumer.

    Ritter is one of the big companies behind Clover. All commissions have to go through Ritter. It is my understanding he is highly thought of in this industry, he should have known better.
     
  4. Chazm
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    Yes chaz. You are so right :)
     
  5. Outdoorsman67
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    Outdoorsman67 New Member

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    I had received the same letter from Clover as well. To my knowledge, they are not allowed to mention that any doctor that accepts Medicare is obligated to accept Clover PPOs as once stated the beginning of this AEP.

    I, 1. Never sold Clover outside of Hudson county because I knew that they are just in the beginning stages of expanding the network (they have half of their captive agents not doing sales anymore, they're paying them salary to do outreach in Dr's offices) and 2. Never had to convince a client with the whole "see any doctor that takes medicare" spiel. So now that CMS has finally brought it to everyones attention, a lot of Extrenal Agents I know are very worried about what they have mentioned to their clients, had they have used common sense from the beginning, they wouldnt have anything to worry.

    Also Im very disappointed at the fact that Captive agents are selling the Premier PPO as a Special Needs Plan, Im just getting around to calling previous clients whom I've signed up for DSNPs and are enrolled in the new Clover PPO plans not knowing that they are going to have to pay for hospital and Rx, not mention lose all the OTC benefits.
     
  6. rhcbp
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    rhcbp Expert

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    You seem to have a good handle on Clover as I do.

    If you find out someone replaced one of your UHC Dual applications with a Clover one and you know who the agent is you should send his/her name to Trenton. As agents we have a responsibility to do the right thing for our clients and there is no way someone could justify selling a Clover plan to someone in a dual snp. They only do it for the commission.

    This industry has to get rid of those type of agents.
     
  7. dolaughlin
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    dolaughlin New Member

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    If you google "Clover health fined", they got the CMS marketing fine for an update....
     
  8. DS4
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    "CMS has determined that Clover engaged in marketing activities during the Contract Year (CY) 2016 Annual Election Period (AEP) that misled or confused potential enrollees about their ability to always receive covered services from any out-of-network (OON) provider, and that Clover failed to correct the misleading statements after repeated notifications from CMS".
     
  9. Northeast Agent
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    I attended a sales presentation the other day, as they are expanding into my county (Bucks) in PA. They will only have one hospital in the county for 2018, and none of the Philly hospitals are yet confirmed.

    They are in NJ already, but several brokers who cover south Jersey weren't too happy with the network there, either although there are more hospitals.

    Needless to say, between the regional Blues, the national carriers and some smaller regional carriers, I don't need them and won't be contracting.
     
  10. Devin01
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    Being from NJ I find this post hilarious. Whenever we use Clover we always check and call the provider to make sure the office accepts Clover. A PPO that has to accept Medicare ... That's funny
     
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