Coventry:

[maryjd123]

Hey Doc

for your advantra rx clients -- are these clients that are doing mailorder? or are they if i understand you right -- sending in claims to be paid that they have already paid for at the pharmacy? im not sure i understand -- could you elaborate?

 

[sman]

I'm ashamed to say that I asked if they were hiring the mentally disabled for tax credits, instead of being concerned for the client.

Love it.

That's part of the frustration with anything new. I just spoke to a client yesterday who went to the ob gyn and was told they didn't accept Medicare Advantage plans becuase they weren't contracted with them. The client called me. I then called the ob gyn office (they are part of a much larger corporation). The girl who handles claims read me the memo she received from corporate that stated,

"We are not accepting Medicare Advantage plans that are PPO and HMO. We will accept Private Fee for Service plans such as Humana GoldChoice and SecureHorizons".

I explained that Today's Options is a Private Fee for Service plan. She then told me it wasn't on her list (only Humana and Secure Horizons). I tried to explain that the letter was only referencing two of the many PFFS plans. She stated the reason they didn't accept them was because they didn't reimburse as much as Medicare. I calmly explained to her that the reimbursement rate is the same as Medicare. She proceeded to tell me I needed to check my facts and then made this statement, "We have a special contract with Medicare". Again, I calmly explained to her that Medicare does not make individual arrangements with providers. She assured me they had one.

At this point (well, really much sooner) I realized I was talking to a genius and was in over my head. So I asked for the number to the person who sent out the memo she read to me. After speaking to this lady, she assured me they DO take Today's Options since it is a Private Fee for Service plan and that they DON'T have any type of special arrangement with Medicare. I asked that she clarify that with all of their offices.

Just another day at work.

 

[Sam]

Nice work. However, you were lucky in that there was someone on top of her who actually did know what was what. Many claims people think that they know everything about insurance, and there is no one to go to over their heads. Then you have a real problem.

 

[policy doctor]

This is the one I referenced when I started this thread. Client paid at the pharmacy because it was rejected bY Coventry at that time. Part of the mixup client caused when she enrolled in Humana, and 3 days later disenrolled. However, although Coventry took her premium without a break, they are not covering claims for last June, July, August.of '06.

BTW...is there a way to track client status online? I would like to track those apps I faxed in to be sure they are logged in.

 

[henryj]

hi guys i have just started with conventry need to know if people with medicaide can benefit with this plan? sorry allow me to introduce myself i am new independent agent was captive with a home service company and I'm now looking into the senior market so far i like you infromative discussions and look forward to learn from you all.

 

[midwestbroker]

Medicaid all depends on the state. In Kansas they can have a MA plan and Medicaid. In Missouri, Medicaid will not pick up any co-pays, so it will not work (unless they have a larger spend down).

The real joy is that if you call 3 different social workers, you will usually get 3 different answers. I would find an agent who is selling Coventry in the state you are in and ask them.

 

[maryjd123]

This is the one I referenced when I started this thread. Client paid at the pharmacy because it was rejected bY Coventry at that time. Part of the mixup client caused when she enrolled in Humana, and 3 days later disenrolled. However, although Coventry took her premium without a break, they are not covering claims for last June, July, August.of '06.

BTW...is there a way to track client status online? I would like to track those apps I faxed in to be sure they are logged in.

Hey Doc -- so the question is -- at that time was she enrolled in the gold plan for humana? or the regular pdp? -- reason i ask -- it takes a little time for the disenrollment from the pffs plan -- it might be covered under humana --- if you want -- give me a call on monday afternoon and if you have her paperwork where she enrolled and disenrolled -- via humana and coventry -- i will call and see if i can help
307-256-7136

 

[policy doctor]

thanks.....no i don't have that paperwork but it got straightened out last Aug '06. Referring to her quick disenrollment.

I have involved Mutual of Omaha and CMS on this....if they can't solve this that's it for me. I'll rewrite her PDP in the fall.

This is a typical example of how a little claim (under !00) can bog you down as an agent. (not to mention the low renewal comm). For years majority Med sups would not pay drugs because of the high claim handling/processing.

 

[henryj]

henryj here is there any coventry Agents in the washington area that can tell me if medicaid will pickup the co-payment,deductable,...etc.? I need to know.

 

[henryj]

washington dc i meant