Doctors Threaten Medicare Backlash

[GreenSky]

I don't understand. When does a patient get paid by a carrier?

If you have a Plan-F and your doc bills you for excess charges do YOU have to make a claim with your carrier to get the money to pay the doc? Is that how it works? (My wife is on Medicare but has a MA PPO plan (Anthem Freedom Blue) and has never had a doc who didn't take assignment.)

Thanks.

Al

The "assignment" is having Medicare and the supplement pay the provider directly. The patient assigns his/her rights to payment.

If a provider does not accept assignment then the patient will be paid and the provider needs to (obviously) collect from the patient.

All Medicare providers must send a bill to Medicare on behalf of the patient, whether they accept assignment or not. The amount of work is the same.

Because of the uncertainty of collecting from a patient, almost all physicians accept assignment. They do this because in the long run it is more cost effective and they collect more money. They are not accepting assignment just to be nice.

On the flip side, there are doctors that accept assignment, receive payment directly, and still balance bill. Those doctors are called crooks. Fortunately for us, fraud in the Medicare system rarely occurs and this is why government run healthcare will be so cost effective.

Rick

 

[Frank Stastny]

I don't understand. When does a patient get paid by a carrier?

If you have a Plan-F and your doc bills you for excess charges do YOU have to make a claim with your carrier to get the money to pay the doc? Is that how it works? (My wife is on Medicare but has a MA PPO plan (Anthem Freedom Blue) and has never had a doc who didn't take assignment.)

Thanks.

Al

If the doctor accepts assignment the patient does not receive the payment, the payment goes directly to the doctor from both Medicare and the insurance company.

If the doctor does not accept assignment then payments from Medicare and the carrier go directly to the patient. Now the doctor has to incur the expense of billing and the risk of patients paying slow or not paying at all. That is the main reason virtually all doctors accept assignment today.

The client never has to file a claim when they are on traditional Medicare. All claims are filed by the doctor directly with Medicare, Medicare then automatically files the claim with the carrier. In the rare cases when a doctor does not accept assignment the doctor sends the patient a bill for the excess charges.

If a client has an MA plan it makes on difference whether or not the doctor accepts assignment. The reason it doesn't is that patient longer has traditional Medicare, Part A & B. A&B have been replaced by MA.

Sorry Rick, we must have been posting at the same time, I didn't see yours before I started typing mine.

 

[GreenSky]

Sorry Rick, we must have been posting at the same time, I didn't see yours before I started typing mine.

You could delete your post and admit that I am the master.

Rick

 

[moonlightandmargaritas]

You could delete your post and admit that I am the master.

You AND Charlie Rangel...

 

[Frank Stastny]

... admit that I am the master.

Okay, I admit it.

We just don't know what you are the master of. Could it be the bass as in "master basser"?

 

[Russ]

I had a lady lined up to write a med-supp on Monday who goes to a gynecologist in Tallahassee. They told her that they will not file Mutual of Omaha(med-supp). She called me yesterday afternoon to tell me what the gynecologists office told her. I advised her that her claims are automatically crossed over from Medicare to her supplement, no matter who she has it with. There's no need for the doctors office to do any supplement filing. She's now hesitant on buying from me since they told her they would file w/BCBS of FL.

Doctors office doesn't know what the heck they are telling her. I even sent her a 2009 Choosing a Medigap Policy booklet this morning since she did not completely believe me. First time I've had this happen that I can recall.

 

[Frank Stastny]

I had a lady lined up to write a med-supp on Monday who goes to a gynecologist in Tallahassee. They told her that they will not file Mutual of Omaha(med-supp). She called me yesterday afternoon to tell me what the gynecologists office told her. I advised her that her claims are automatically crossed over from Medicare to her supplement, no matter who she has it with. There's no need for the doctors office to do any supplement filing. She's now hesitant on buying from me since they told her they would file w/BCBS of FL.

Doctors office doesn't know what the heck they are telling her. I even sent her a 2009 Choosing a Medigap Policy booklet this morning since she did not completely believe me. First time I've had this happen that I can recall.

It was probably the "little girl" with one finger in her dimple and the other one texting her boyfriend. I have had similar things happen in the past. It is too bad that we live in a world with so much ignorance and incompetence.

Actually, there is no logical reason for the doctors office to even retain a copy of their supplement ID card. The doctor only need to know that they have a Med Supp. The doctor will most likely never have a need to communicate directly with the insurance company.

It would be best to talk to your client and explain the entire Medicare claims process. That will also dispel any concerns she has about how well the new company is going to pay her claims. It is seniors biggest concern and most often the reason they do not change to a new company even though the agent can save them money.

 

[Russ]

It was probably the "little girl" with one finger in her dimple and the other one texting her boyfriend. I have had similar things happen in the past. It is too bad that we live in a world with so much ignorance and incompetence.

Actually, there is no logical reason for the doctors office to even retain a copy of their supplement ID card. The doctor only need to know that they have a Med Supp. The doctor will most likely never have a need to communicate directly with the insurance company.

It would be best to talk to your client and explain the entire Medicare claims process. That will also dispel any concerns she has about how well the new company is going to pay her claims. It is seniors biggest concern and most often the reason they do not change to a new company even though the agent can save them money.

I talked to her on the phone for 20-30 minutes yesterday. She was looking at PFFS plans on her computer. I explained to her how they work.... along with what I mentioned in my previous post.

I sent her the above mentioned Medicare booklet today along with a two-page letter I wrote to her explaining Medicare and how it coordinates with supplements. Even listed the page number of the Medigap policy booklet, that talks about how medigap plans get/pay the Medicare bills.

She has a neighbor that she knows that has had her supplement with me since April of 1997. I told this lady that I've never had to file a claim for her neighbor because of the automatic claim filing benefit. Ninety-nine pct. of those I talk to never express doubt in what I tell them with anything like this. This lady did. Maybe I'll still convince her.

 

[Frank Stastny]

I talked to her on the phone for 20-30 minutes yesterday. She was looking at PFFS plans on her computer. I explained to her how they work.... along with what I mentioned in my previous post.

I sent her the above mentioned Medicare booklet today along with a two-page letter I wrote to her explaining Medicare and how it coordinates with supplements. Even listed the page number of the Medigap policy booklet, that talks about how medigap plans get/pay the Medicare bills.

She has a neighbor that she knows that has had her supplement with me since April of 1997. I told this lady that I've never had to file a claim for her neighbor because of the automatic claim filing benefit. Ninety-nine pct. of those I talk to never express doubt in what I tell them with anything like this. This lady did. Maybe I'll still convince her.

You are a pro, I'm sure you won't have any trouble doing so.

 

[Yoda]

I sent her the above mentioned Medicare booklet today along with a two-page letter I wrote to her explaining Medicare and how it coordinates with supplements. Even listed the page number of the Medigap policy booklet, that talks about how medigap plans get/pay the Medicare bills.

Good grief!....A two page letter!....Thats almost going to far man! I mean she might be thinking your desperate if youre sending her 2 page letters trying to make the sale. Man oh man oh man I aint doing it. I aint that poor. Ive never sent out out no letters like that in 25 years. And lets not forget its a tricky deal when you leave written material with a customer and the Department of Insurance gets a hold of it. I mean you think people pick your words over on forums like this just wait until some dept of insurance investigator gets a hold of that letter and goes over it with a fine tooth comb. This is golden so remember it "AS A RULE ITS ALWAYS A GOOD IDEA TO LEAVE THE CLIENT WITH ONLY PRE APPROVED LITERATURE PRINTED UP BY THE INSURANCE COMPANIES". That rule is golden did I say that yet. I dont think you had a lawyer proof read that 2 page letter before you sent it out did you? When the insurance companies print up their marketing brochures they have their legal dept scrutinize it over and over before they release it. You have got to be careful. You will probably be alright this time but dont do that anymore. What Im reading into the situation is you lost the ladies confidence somewhere. You needed to pull out a calm cool laid back answer that sounded good right there and then and nip the problem in the bud. But you didnt and now your chasing it. Im not you and your not me but if it was me I would of went for all or nothing right there on the phone.