GTL Does Not Participate in Crossover

somarco

GA Medicare Expert
5000 Post Club
36,602
Atlanta
South GA client has been going to Mayo (JAX) for about 2 years now. Mayo does not accept Medicare assignment. He has plan G.

GTL claims are a mess.

Several eligible claims have not been paid. GTL says they never got them. And they frequently deny xs charges.

Sometimes GTL pays Mayo direct. Sometimes they pay the client.

Appointed through @ritter. They have intervened several times to get the claims paid. GTL promises to never do it again.

And then they lapse back into their old ways and forget to pay xs.

Who should come down on them? The DOI? Medicare?

This is so frustrating. I would move him somewhere else but I can't. Client has been very patient, more than I would be. I don't know how many claims have not been paid because GTL says they never received them.

How many carriers never signed on for crossover? Why would a carrier not participate?
 
I'd say maybe send a same letter to the GA DOI, GTL's headquarters State DOI and maybe the GA Medicare Regional Office?

Not sure if the last one will do anything, sounds more like a DOI issue, albeit a slow, painful process.
 
I have reached out to my @ritter contact. Hopefully I will hear from him on Monday.

May still also contact GA DOI.

I doubt anyone at GTL HO really gives a damn.
 
South GA client has been going to Mayo (JAX) for about 2 years now. Mayo does not accept Medicare assignment. He has plan G.

GTL claims are a mess.

Several eligible claims have not been paid. GTL says they never got them. And they frequently deny xs charges.

Sometimes GTL pays Mayo direct. Sometimes they pay the client.

Appointed through @ritter. They have intervened several times to get the claims paid. GTL promises to never do it again.

And then they lapse back into their old ways and forget to pay xs.

Who should come down on them? The DOI? Medicare?

This is so frustrating. I would move him somewhere else but I can't. Client has been very patient, more than I would be. I don't know how many claims have not been paid because GTL says they never received them.

How many carriers never signed on for crossover? Why would a carrier not participate?
I'm not offering GTL's Med Supp(not competitive), but UNL did the crossover and I never had a single problem with them. That was GTL's offering at the time.
 
Clients rarely run into issues with crossover or xs. AFAIK, GTL is the only carrier I use that has not signed on for xover.

GTL hit the state two years ago with killer rates and HH discount if you lived with someone 18 or older. Fortunately only sold a handful of policies and managed to roll a few of them to other carriers once I found out they would be a problem.

This client is opening my eyes to issues on xs. Something I did not consider.

Apparently Mayo has providers who are not on staff but contractors. At least some of the contractors accept assignment, Mayo does not. So some of the claims should be paid direct while others paid to the patient.

Can you say SNAFU?

This would not be a problem if GTL participated in xover and knew how to properly adjudicate claims.

I have a few other south GA clients with F or G but with different carriers. They will also go to Mayo from time to time. No claim problems.
 
Reason number 57 to stick with your core carriers and don’t chase rates. Especially when a carrier drops their rates to gain market share. I’m sorry your client is dealing with this issue.
 
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