CMS asked to cap commissions

[retread]

I would like to comment about all doctors taking MA's and just to make to clear."All doctors who take Medicare should take MA's." I totally agree and I still belive that to this day. The BS that they can take you and not your friend is crazy.

Lets make things as confusing as possible!

I agree that all doctors who are Medicare eligible should be required to accept all MA patients. MAs are part of Medicare.

I do not think this is a "free-market" issue. I do not think doctors should be made to take patients in general... they have their own business to run. But IF they subscribe to Medicare, THEN, since MAs are part C, they should therefore be required to accept them.

If they close their doors due to patient load, fine. If they no longer wish to serve Medicare patients, that's fine, too.... (many are doing this now). But make MAs as acceptable as Original Medicare if they continue their subscription to the program. All or none, baby!

 

[Frank Stastny]

I would like to comment about all doctors taking MA's and just to make to clear."All doctors who take Medicare should take MA's." I totally agree and I still belive that to this day. The BS that they can take you and not your friend is crazy.

Lets make things as confusing as possible!

I agree that things are way out of control and confusion level keeps building and building. I'm so sick of the crap coming down from CMS, not daily anymore but almost hourly.

None of this was even an issue until the PFFS crap hit the fan. I didn't like it when it first started and I dislike it even more.

I do have to disagree with you though. Doctors should not be forced to accept PFFS plans. That is akin to them telling me that I have to sell them. Or, telling me that I cannot sell PFFS plans even though I make a living working in the senior market. I became an independent agent so I can do as I please.

I do understand where you are coming from though and feel your frustration. It is CMS that is flawed. They have come up with a crappy plan and the way they are running it becomes more of a joke and a cluster ah mess daily. I just can't put the blame on the doctors.

 

[retread]

I agree that things are way out of control and confusion level keeps building and building. I'm so sick of the crap coming down from CMS, not daily anymore but almost hourly.

None of this was even an issue until the PFFS crap hit the fan. I didn't like it when it first started and I dislike it even more.

I do have to disagree with you though. Doctors should not be forced to accept PFFS plans. That is akin to them telling me that I have to sell them. Or, telling me that I cannot sell PFFS plans even though I make a living working in the senior market. I became an independent agent so I can do as I please.

I do understand where you are coming from though and feel your frustration. It is CMS that is flawed. They have come up with a crappy plan and the way they are running it becomes more of a joke and a cluster ah mess daily. I just can't put the blame on the doctors.

Frank, it shouldn't matter to a doctor whether the patient is on a PFFS or a Med Sup. Both are private insurance carriers. The PFFS carrier cuts out the need to deal with Medicare and they bill the carrier directly, so there should be some benefit to them to accept the PFFS.

What got the doctor's panties in a wad last year, was that Congress wanted to take funds originally set aside for their raises and fund expansion of the MA program of which PFFS plans were a part. I don't blame them for getting angry. I would be, too, if I was in their shoes... but that is now history. They got their raise and things have settled down.

The issue with unethical sales agents misrepresenting PFFS plans was a separate issue and really didn't affect the doctors much. It did raise the issue that doctors did not have a contract with the PFFS carrier and therefore were free to turn down a patient. That the beneficiary was mislead into thinking they had to be served was the problem. CMS addressed that problem with a sledge hammer, and now that is resolved, too.

It was just co-incidental that both issues came up at the same time.

 

[floridabroker]

Frank,

it's just this....... If they are so concerned about the senior and pretty much have cart blanche on what they can do......... How would that hurt the senior??

Of course it would benefit them more than anything CMS has ever done!!!

I heard someone on the radio the other day in regards to Pharmacies electing not to dispense the morning after pill.

The caller said they should have to because it was for the greater good of the people and they shouldn't be able to spout their views.

OK...so for the greater good make doctors accept MA's.

And again when the money is the same???

Sorry Frank you need to participate in Bidens america.

 

[retread]

Frank,

it's just this....... If they are so concerned about the senior and pretty much have cart blanche on what they can do......... How would that hurt the senior??

Of course it would benefit them more than anything CMS has ever done!!!

I heard someone on the radio the other day in regards to Pharmacies electing not to dispense the morning after pill.

The caller said they should have to because it was for the greater good of the people and they shouldn't be able to spout their views.

OK...so for the greater good make doctors accept MA's.

And again when the money is the same???

Sorry Frank you need to participate in Bidens america.

I am not speaking for Frank, but your logic escapes me. Somewhere in this discussion you are trying to make a point, but I can't deal with your rationale. Could you re-phrase your argument?

 

[dandan]

For the greater good make the Doctors accept MA plans!

Good Grief....

Also lets take children at age 6, and teach them a trade we think suits them best!

 

[retread]

For the greater good make the Doctors accept MA plans!

Good Grief....

Also lets take children at age 6, and teach them a trade we think suits them best!

Several countries have tried this, Russia and China come to mind, but it seems it didn't work out too great!

 

[Frank Stastny]

Frank, it shouldn't matter to a doctor whether the patient is on a PFFS or a Med Sup. Both are private insurance carriers. The PFFS carrier cuts out the need to deal with Medicare and they bill the carrier directly, so there should be some benefit to them to accept the PFFS.

Ed,

I don't see that cutting out the necessity of doctors having to deal with Medicare is any kind of a plus for doctors or anyone for that matter. I hear doctors complain about HMO's and PFFS plans but very rarely hear them bitch about having to deal with Medicare. I don't understand the point you were trying to make.

I'm not trying to be argumentative but right now doctors do not have to accept Medicare patients nor do they have to accept Assignment. If you support doctors having to accept all MA plans do you also support them having to accept Medicare and also accept Medicare Assignment?

Right now in metro areas there are doctors who do not accept any of the HMO's. There are reasons why they don't and with some of them it has nothing to do with the amount they get paid.

HMO's to varying degrees will dictate to the doctor what test or procedure the doctor can order. If the HMO says they will not approve it then the doctor's hands are tied in providing what he/she thinks is in the best interest of their patient.

Some doctors feel that their medical training enables them to more of an educated decision regarding their patients well being than an administrator with an MBA who works for an HMO and who is only interested in the "bottom line".

I believe that there are agents who really don't care about that either. Like HMO administrators they are more interested in the amount of money they believe they will be paid when they sign someone up.

We didn't hear anything about this until the advent of the PFFS plans. Both agents and providers appeared to be very happy with the way things were going.

Just a few years ago the professional agents working in the metro areas were offering HMO's and had the ability to help the prospect make a well informed, intelligent decision regarding the type of coverage that was in the best interest of the prospect.

Enter the PFFS plans and the agents who got into the senior market just because they heard that there was a lot of "easy money to be made". That is when the sheit hit the fan. CMS went ballistic, seniors began getting ripped off and doctors got pissed.

We have seen over and over again what happens when the government starts dictating what MUST or cannot be done. That is exactly what is going on with this thread. Agents are up in arms because the government is going to dictate the commissions that will be paid when a PFFS plan is placed. They are afraid that they will no longer be the big windfall that they have been in the past.

You said that doctors should now be happy since they got their raise. Let's assume that is true and there doesn't appear to be a logical reason for them not to agree to accept all MA plans. So Congress makes it mandatory.

Congress now has a huge smile on their face. Know why? Because they can now come back and initiate the cut in what doctors are being paid and the doctors will have no choice but accept it. They won't even be able to decide that they don't want to accept MA patients because it is MANDATORY.

I cannot support any measure that further takes away a business owners right to run their business the way they see fit.

 

[retread]

Ed,

I don't see that cutting out the necessity of doctors having to deal with Medicare is any kind of a plus for doctors or anyone for that matter. I hear doctors complain about HMO's and PFFS plans but very rarely hear them bitch about having to deal with Medicare. I don't understand the point you were trying to make.

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The fact that they don't have to send a claim to Medicare, wait for it to be approved, then send the balance to the Med Sup carrier to be considered is my thought.... with only one carrier to submit a claim to would seem to be more efficient.... that's all.

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I'm not trying to be argumentative but right now doctors do not have to accept Medicare patients nor do they have to accept Assignment. If you support doctors having to accept all MA plans do you also support them having to accept Medicare and also accept Medicare Assignment?

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No, that is not what I said. I said IF they decided to accept a Medicare patient, THEN they should have to accept a MA member.[/quote]
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Right now in metro areas there are doctors who do not accept any of the HMO's. There are reasons why they don't and with some of them it has nothing to do with the amount they get paid.

HMO's to varying degrees will dictate to the doctor what test or procedure the doctor can order. If the HMO says they will not approve it then the doctor's hands are tied in providing what he/she thinks is in the best interest of their patient.

Some doctors feel that their medical training enables them to more of an educated decision regarding their patients well being than an administrator with an MBA who works for an HMO and who is only interested in the "bottom line".

I agree. Always saw it this way... I have been on the butt end of this problem myself years ago when I was a member of KP HMO.
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I believe that there are agents who really don't care about that either. Like HMO administrators they are more interested in the amount of money they believe they will be paid when they sign someone up.

Sad, but true...
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We didn't hear anything about this until the advent of the PFFS plans. Both agents and providers appeared to be very happy with the way things were going.

Just a few years ago the professional agents working in the metro areas were offering HMO's and had the ability to help the prospect make a well informed, intelligent decision regarding the type of coverage that was in the best interest of the prospect.

Enter the PFFS plans and the agents who got into the senior market just because they heard that there was a lot of "easy money to be made". That is when the sheit hit the fan. CMS went ballistic, seniors began getting ripped off and doctors got pissed.

Yeah, I know... this is where I came in. I got burned bad by an upstart organization headed up by a former UA manager. What a mess...

I have to admit, that I was taken in by this group since I was a brand-new agent and didn't know any better. I did not take me long to come to the realization that I needed out.... quick!
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We have seen over and over again what happens when the government starts dictating what MUST or cannot be done. That is exactly what is going on with this thread. Agents are up in arms because the government is going to dictate the commissions that will be paid when a PFFS plan is placed. They are afraid that they will no longer be the big windfall that they have been in the past.

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Yes, and I can understand to a good degree. Those who saw a good business opportunity, and worked to build a business around it, and those who saw only a quick buck and never had plans to do their due diligence and study to become well-qualified. I have a distaste for the latter.
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You said that doctors should now be happy since they got their raise. Let's assume that is true and there doesn't appear to be a logical reason for them not to agree to accept all MA plans. So Congress makes it mandatory.

Congress now has a huge smile on their face. Know why? Because they can now come back and initiate the cut in what doctors are being paid and the doctors will have no choice but accept it. They won't even be able to decide that they don't want to accept MA patients because it is MANDATORY.

Very good point!
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I cannot support any measure that further takes away a business owners right to run their business the way they see fit.

I agree, up to the point where once a doctor agrees to accept Medicare assignment. At that point he/she should have to take the whole package, and that includes Part C.

(I hope this attempt to multi-quote works... I can't find the directions on the box!)

 

[Frank Stastny]

-

(I hope this attempt to multi-quote works... I can't find the directions on the box!)

Ya done good!

I still don't agree with everything you said but that's okay, you said it well.