Dental/Vision/Hearing

[texaslady]

How in the world are you only getting 25% commission? I offer them and the lowest contract that I see is 45% in TX.

That may be what it is, I probably misspoke. I don't keep track because it's so low anyways, I just use this product as a way to build a relationship and write bigger business later.
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That is only half the answer. And you did not say what percentile they use for R&C.

Do you also have a list of charges for procedures by dentists in the area?

Okay, I'm not sure what percentile they use, honestly I'm not 100% sure exactly what a percentile is in this respect.

All I know, is that I was about to sell a Constitution plan to a client who needed a new crown. She had Delta dental, and they weren't paying hardly anything, she was very unhappy. I wanted to make sure that Constitution would pay for this before I signed her up, so I did a ton of research, only to find out that in the end, most of these dental plans are a huge rip off! They would've covered such a small percentage of the cost, it was not worth it at all! And I knew if I sold that to her, she would hate me forever. That's the last time I jump through hoops for that tiny commission, you live and you learn. Oh well.

That's how I found out about Medico, it was actually recommended to me by another agent who is also a senior citizen. He has good feedback from this policy. When I inquired about their "reasonable and customary" charges, I don't remember exactly what the numbers were, but I did a side by side comparison with Constitution and found the Medico was better. This was a while back, and who knows what has changed since then....

The Medico is an indemnity plan, they can go to whomever they want, but they have to pay full price and get reimbursed. Which although sounds like a hassle, what I've found is that these seniors are already used to paying full price out of pocket for their dental/vision, so they're used to it. Also, the fact that they can go to whichever dentist they want is a good selling point, IMO. From what I've heard through the grapevine, Medico is really good at reimbursing the clients.

 

[somarco]

I'm not 100% sure exactly what a percentile is in this respect.

Carriers establish their own R&C guidelines then set up their formula based on that.

If a procedure is $1000 according to their R&C and they want to pay in the 80th percentile and the coinsurance is 80% then they would pay $1000 x .8 x .8 = $640 for what they consider to be reasonable.

If the dentist bills $1400 then the plan pays 45% of the actual bill.

 

[goldthroat]

I like the Medico DVH plan. To answer a couple of questions. It has a 30 day wait for first cleaning. No wait for fillings, extractions, etc. 6 mos wait for root canals, 1 yr wait for dentures & hearing aids. They pay claims quick and insureds can go to any dentist. It stays on the books, travels well & pays in the 90th percentile. It's also a great door opener to other business. I have a couple of captive Medicare Advantage agents who's plans do not cover dental that pass out my brochures and I get calls all the time from these folks. There is a similar plan out there from Commercial Travelers that covers up to 90% but I don't know much about this plan or company. Medico has been around a long time and they shoot straight with the agent and the insured.
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I like the Medico DVH plan. To answer a couple of questions. It has a 30 day wait for first cleaning. No wait for fillings, extractions, etc. 6 mos wait for root canals, 1 yr wait for dentures & hearing aids. They pay claims quick and insureds can go to any dentist. It stays on the books, travels well & pays in the 90th percentile. It's also a great door opener to other business. I have a couple of captive Medicare Advantage agents who's plans do not cover dental that pass out my brochures and I get calls all the time from these folks. There is a similar plan out there from Commercial Travelers that covers up to 90% but I don't know much about this plan or company. Medico has been around a long time and they shoot straight with the agent and the insured.

Excuse me..That's a 3 month wait for the first cleaning.

 

[insurance0707]

I've been writing the UCT dental, vision and hearing plan. I liked it so much, I took it out myself. I've only had it 7 months. I had to wait 3 months before it would cover my cleaning. My dentist billed $75 for the cleaning and $40 for the exam. Uct paid $75 for the cleaning (they pay 100% of a cleaning up to $75 each year) and they paid 60% of the $40. I just got eye glasses. I was charged $235 for the glasses/lenses. UCT paid 60% of the $235. From the two claims that I've turned in, they haven't used any reasonable or customary charges, they're just going by what the dentist or provider is charging. I actually called down to UCT and they told me that unless it was some outragous amount, like $300 for a cleaning, that they just pay whatever the charge is. They figure it's a limited benefit policy and there's only so much that they have to pay anyways.

I have a crown that my dentist keeps bugging me about. In February, after I've had the plan for 12 months, UCT will pay 70% of the bill. (60% 1st year 70% 2nd year 80% 3rd year and 90% 4th year and thereafter)

 

[bigeats]

I've been writing the UCT dental, vision and hearing plan. I liked it so much, I took it out myself. I've only had it 7 months. I had to wait 3 months before it would cover my cleaning. My dentist billed $75 for the cleaning and $40 for the exam. Uct paid $75 for the cleaning (they pay 100% of a cleaning up to $75 each year) and they paid 60% of the $40. I just got eye glasses. I was charged $235 for the glasses/lenses. UCT paid 60% of the $235. From the two claims that I've turned in, they haven't used any reasonable or customary charges, they're just going by what the dentist or provider is charging. I actually called down to UCT and they told me that unless it was some outragous amount, like $300 for a cleaning, that they just pay whatever the charge is. They figure it's a limited benefit policy and there's only so much that they have to pay anyways.

I have a crown that my dentist keeps bugging me about. In February, after I've had the plan for 12 months, UCT will pay 70% of the bill. (60% 1st year 70% 2nd year 80% 3rd year and 90% 4th year and thereafter)

That's good to hear, Ins0707. We're appointed with them, though I haven't taken an app, yet. Always good to hear some positive reviews before recommending one of these kinds of plans.

 

[insurance0707]

Has anyone taken out the Medico plan and used it? I was wondering if they pay what the providers charges or are they using reasonable & customary? The premiums are a little lower with Medico that's why I'm asking. UCT gives you more options though, you can have a $0 deductible or a $100 deductible. Most of my clients are going with the $ 0 deductible. Medico only offers their plans with a $100 deductible.

Thanks for the feedback bigeats....

 

[somarco]

I was wondering if they pay what the providers charges or are they using reasonable & customary?

I have never seen a fully insured plan pay based on what the provider charges. DR plans will follow whatever the provider charges which is why dentists love them.

 

[insurance0707]

The two claims I've filed with UCT used the actual charges. The home office told me that's basically what they do, unless the dentist or provider charges some ridiculously high amount

 

[somarco]

used the actual charges. The home office told me that's basically what they do, unless the dentist or provider charges some ridiculously high amount

That's useful.

We use A unless A is too high then we pay using B.

 

[insurance0707]

That's useful.

We use A unless A is too high then we pay using B.

No, they actually said that because this is a limited benefit plan that they just pay what the dentist or provider charges, they'll only use R&C if the dentist or provider is way out of line. From the two claims I submitted, they paid on what the provider billed. My dentist isn't cheap and they have paid based on what he billed. I use Ameribest for my vision and Ameribest is pretty reasonable. Again, they just paid the claim based on what was charged.

I know most dental/vision plans don't do this, that is one of the reasons why i really like this plan, on top of the fact that they can go to any provider they like. It's not a network based plan.

If you have clients that need fillings, tooth extraction, dental exams, x-rays, eye exams, hearing exams those service are covered at 60% immediatly during the 1st year.

Somarco, I've noticed that you always kind of bad mouth any dental plan that's brought up on this site but never mention who you use. When I brought up UCT in a previous post you brought up this whole thing about R&C and the percentile that the insurance company is using...to be honest that is one of the reasons why I took out the plan myself, to see what they actually paid. Also, I needed the coverage anyways. I was pleaseantly suprised to see the company just paid based on the claim, they didn't use R & C. I wanted to pass the info onto other agents. I also was wondering if Medico did the samething. So just out of curiousity, what wonderful dental plan are you showing your clients, because you don't seem to ever bring one up. Have you taken this plan out on yourself to see how it pays?

....nevermind..i looked at your website and see what you're offering..hmmmmm

this is you right? Senior Dental Insurance Plans - Medicare Dental Insurance