DSNP vs non-dual LPPO with medicaid

Jul 22, 2019

  1. bmarsh
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    bmarsh Super Genius

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    Client is on UHC Medicaid Dual Complete RPPO, she wants silver sneakers.

    If she enrolls in a non-dual LPPO w/ silver sneakers, and I put the medicaid # on the app, will they still charge copays?

    If its a medicaid provider, can they bill medicaid the copays?
     
    bmarsh, Jul 22, 2019
    #1
  2. timeflies
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    timeflies Super Genius

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    The application should not have anything to do that. It is based on the provider's office and what their practices are. I have had folks that became eligilble for Medicaid after joining a non DE SNP plan and even if they show their Medicaid card, the staff still tries to collect a co payment. In Ohio, providers cannot charge Medicaid recipients for services, but some of them do it anyway. UHC still has their own fitness program, but it does not have Silver Sneakers classes or the same fitness centers as Silver Sneakers. Most other plans do not have as many extras as the dual plans either.
     
  3. policywunk
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    policywunk Expert

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    That would be a terrible idea because they would have to go to medicaid providers only and then the member has to submit the claims to medicaid themselves.Not to mention losing 2500 of dental,880 of OTC etc that the UHC plan offers.If this goes south you would be facing a major complaint about suitability. Suggest that she can buy a gym membership for as little as 10.00 a month -often fitness centers will reduce their prices for low income or refer it to another agent with a dual plan that has a fitness benefit if available.
     
  4. Chazm
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    Chazm Guru

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    Planet fitness is already $10/month
     
    Chazm, Jul 24, 2019
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