Drs Refusing Medicare?

abcsales

Super Genius
100+ Post Club
231
2 clients in 2 days both had drs send a letter saying they will no longer be taking original medicare, if they want to continue at that practice they much get a MA plan. One even refuses to take cash from Medicare patients.

One guy has multiple health issues, has to see the dr monthly to get his rx refilled, however doesn't want to join a ma plan.

Suggestions??

This isn't my first AEP, however first I"ve heard that drs can just leave Medicare???
 
Dr's can opt out of Medicare if they want to, but it doesn't make sense that the letter is advising them to get a MA Plan so that they can still see the Dr.

Usually, if a Dr. doesn't accept Medicare assignment then they won't see Medicare patients at all.

While a Dr. doesn't have to accept assignment to take MA Plans, they can still charge extra that the patient will have to pay out of pocket....at least I believe this is the case.
 
Last edited:
sounds like someone is getting a kickback in one situation where they said you must take a certain MA to see this dr, no cash pay allowed.

One client asked me if they can get a MA plan to see a particular dr and use supp with other drs. I told client I couldn't endorse such a situation and would not sell him a MA plan to do that. BUT-
--can someone do that??

I did have a client a few years ago who signed up for a MA with another agent and didn't cancel his supp. He didn't realize he was still paying for months he didn't use it.

Page 35 in Choosing a Medigap plan---if you decide to keep your Medigap plan, you will have to pay your premium, but gap plan won't pay any deductibles, copayments or coinsurance or premiums under MA plan. So if you want to join a MA plan, you may want to drop your Medigap plan.

Makes me think the client could get a no cost MA plan and only use it to see that particular dr?? Thoughts??
 
This is purely a doctor that is not getting timely payments from Medicare. It can take 6 months to get paid or longer. MA plans are a prepaid arrangement with Medicare and this is why he will accept MA.

It is not unusual to also not take case from medicare patients as this can effect their reimbursements from Medicare.

It is purely a billing issue only. Got to love the efficiency of Gov't paid healthcare.
 
Last edited:
sounds like someone is getting a kickback in one situation where they said you must take a certain MA to see this dr, no cash pay allowed.

One client asked me if they can get a MA plan to see a particular dr and use supp with other drs. I told client I couldn't endorse such a situation and would not sell him a MA plan to do that. BUT-
--can someone do that??

I did have a client a few years ago who signed up for a MA with another agent and didn't cancel his supp. He didn't realize he was still paying for months he didn't use it.

Page 35 in Choosing a Medigap plan---if you decide to keep your Medigap plan, you will have to pay your premium, but gap plan won't pay any deductibles, copayments or coinsurance or premiums under MA plan. So if you want to join a MA plan, you may want to drop your Medigap plan.

Makes me think the client could get a no cost MA plan and only use it to see that particular dr?? Thoughts??

They can get an MA plan and keep paying on the med sup but I can't imagine why they would want to. The med sup will not and cannot pay any claims while the person is in the MA plan.

They cannot have both and use them situationally.

It's flabbergating that someone is certified to sell MA and is asking these basic questions.
 
Quick question for the OP - is this in WA? I have seen that situation there before. I'm curious if this is spreading.
 
The doctor likely receives a capitation north of $40 per month per patient. It may be more profitable for him to have an obamaload of patients at $480 a year than bother with any billing issues.

Remember that Medicare hasn't raised what a doctor earns in 15 or so year.

Why would a doctor want to lose money?

We're not quite where the democraps can require a doctor who is in Medicare to remain there forever. Not yet.

Rick
 
Got to love the efficiency of Gov't paid healthcare.

Except that Medicare does not pay claims. They farm it out to a carrier or TPA.

doctor likely receives a capitation north of $40 per month per patient.

Is that only in an HMO or does it apply to PPO plans as well?
 
Is that only in an HMO or does it apply to PPO plans as well?

PPO plans don't pay docs PMPM. I was referring to HMOs.

In LA the primary care doc usually received $45 or more per month per patient. Of course, there are rarely any copays so they get see patients who get their health care for FREE! Just like preventive care and breast pumps from Obamacrap.

Rick
 
and Obozocare requires everybody (including males) to have maternity coverage..;) NO joke.

Chances of a male to get pregnant..well you do the math.
 
Back
Top