I was at a presentation last week for a new MAPD plan in New Jersey. The plan is a PPO, MAPD. $0 to see a pcp in network, $0 to see a pcp out of network, $0 to see a specialist in network and $0 to see a specialist out of network.
My question to the presenter was that if a member went to a doctor out of network the office staff will say we do not accept Clover. His reply was that if a doctor accepts Medicare he has to accept the PPO. He even went as far to show everyone a picture of the back of the card which stated that it is unlawful for a doctor who accepts Medicare not to accept a PPO.
Does anyone know if this is true? Everything I can find on the Medicare website states that if you use a PPO you may have to pay more out of network, nothing about if a doctor has to accept the plan or not.
My question to the presenter was that if a member went to a doctor out of network the office staff will say we do not accept Clover. His reply was that if a doctor accepts Medicare he has to accept the PPO. He even went as far to show everyone a picture of the back of the card which stated that it is unlawful for a doctor who accepts Medicare not to accept a PPO.
Does anyone know if this is true? Everything I can find on the Medicare website states that if you use a PPO you may have to pay more out of network, nothing about if a doctor has to accept the plan or not.