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Guaranteed Issue - Health Insurance Innovation?
- Thread starter Suis
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- 14,809
It's nice to talk to agents who know nothing about how billing works - like I used to know nothing when I was new.
No hospital or provider is under any obligation to bill the procedure at Medicare reimbursement rates nor will they. They'll bill at Medicare rates for Medicare patients. Period.
Although these mini-meds can indeed get network re-pricing it's a pittance - generally 10% or so off the tab.
No provider be it a doctor or hospital is going to schedule a procedure without payment being deal with upfront.
What happens in the cases of these mini-meds is the provider calls the carrier and states they need pre-authorization for John Smith's gall bladder procedure. That's when the gig is up and the hospital finds out the Mr. Smith has a mini-med that only reimburses according the Medicare schedules. The hospital says "that's great but we're not contractually obligated to do this procedure at Mediare rates, nor will we."
You have a lot to learn before cramming people into this stuff. If you're selling this and promising your clients that providers have to bill at Medicare reimbursement rates, get a good attorney. If you're selling this and promising people big network discounts, get that same attorney.
No hospital or provider is under any obligation to bill the procedure at Medicare reimbursement rates nor will they. They'll bill at Medicare rates for Medicare patients. Period.
Although these mini-meds can indeed get network re-pricing it's a pittance - generally 10% or so off the tab.
No provider be it a doctor or hospital is going to schedule a procedure without payment being deal with upfront.
What happens in the cases of these mini-meds is the provider calls the carrier and states they need pre-authorization for John Smith's gall bladder procedure. That's when the gig is up and the hospital finds out the Mr. Smith has a mini-med that only reimburses according the Medicare schedules. The hospital says "that's great but we're not contractually obligated to do this procedure at Mediare rates, nor will we."
You have a lot to learn before cramming people into this stuff. If you're selling this and promising your clients that providers have to bill at Medicare reimbursement rates, get a good attorney. If you're selling this and promising people big network discounts, get that same attorney.
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- 5,056
Well, just make sure you use a service like RingCentral where you can record you're calls to protect yourself.
If someone is one a mini-med, they still will have signficant medical bills, but at least those bills will be significantly reduced.
I assume you are referring to GoldenRule, who to the best of my knowledge is the carrier that may pay a reduced commission on hipaa cases depending on where you live.
Like HealthAgent said, you won't be able to help everyone.
Do you think lawyers make it a habit of taking on cases they know they don't have a chance of winning? Sometimes you just have to let a lost cause go.
And please for the love of God, don't buy uninsurable leads with the idea you'll be able to sell them mini meds all day long, like the call centers do. It doesn't work.
Just research all the mini meds, find a 1-2 you can stomach and contract with those plans, and be frank with you're clients about how it actually works in real life. Stay away from any plan that has an app fee above $25, and/or affiliated with anyone from AIM health plans.
Docs and hospitals discount for cash, especially these days. Doesn't matter if you have a mini med or just a discount card. Without the cash to pay, no deals.
And you can forget about $10 down and $10 per month. That won't cut it.
Providers will come off 40 - 60% if you have cash.
And you can forget about $10 down and $10 per month. That won't cut it.
Providers will come off 40 - 60% if you have cash.
- 4,707
Quoted for truth!
Lets say you have no health insurance and need a procedure done in the hospital, by a physician. You could ask the hospital/physician,"I don't have any health insurance. What is you cash price for this procedure?".
You would probably pay LESS than the discounted price from the mini med.
- 14,809
If an agent went over the details about exactly how a mini-med worked they wouldn't sell any.
They have to be hyped with "big network discounts" and "providers bill at Medicare reimbursement rates" both of which are lies.
At the end of my pitch my client would say:
"Ok, so let me get this straight. I'm better off just paying out of pocket for the small stuff instead of paying that $250/mo premium and it doesn't cover any large stuff? So what's it do?"
Me: "Nothing."
My biggest beef is clients are being taken great advantage of regarding the premiums. These are near major medical premiums being charged for 1/1,000th the benefits provided.
They have to be hyped with "big network discounts" and "providers bill at Medicare reimbursement rates" both of which are lies.
At the end of my pitch my client would say:
"Ok, so let me get this straight. I'm better off just paying out of pocket for the small stuff instead of paying that $250/mo premium and it doesn't cover any large stuff? So what's it do?"
Me: "Nothing."
My biggest beef is clients are being taken great advantage of regarding the premiums. These are near major medical premiums being charged for 1/1,000th the benefits provided.
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- 8,448
It's amazing that the restaurant industry's (McDonald's, et.el.) threat to drop their Mini-Med plans caused such a ruckus and forced concessions from the government this past week. Based on this, I would surmise that Mini-Meds are better than NOTHING..for the average person. (Not the rare, saavy consumer who can negotiate to pay cash.)
-A.C.
-A.C.
- 15,041
Hardly. It is just a great PR line to use against Obama and those who voted for HCR. They could point to how it caused people to lose coverage. The quality of coverage, or the lack of quality was irrelevant.
I have had calls from CDC contract workers that have a crap Starbridge plan. One lady a few years ago had some issues, appendicitis maybe, can't recall. Ended up with around $25,000 in charges and the plan paid about $1500.
She was practically in tears when she called looking for something.
I really hate to get calls like that but nothing I can do.
No, I can't help everyone but I can sleep well at night knowing I have never recommended something I would not buy for myself or my family.
Vol is right. Mickey D was playing HHS like a fiddle and it worked like a charm.
Obamacrap is coming apart at the seams. The have now granted waivers to 30 companies and unions with mini meds. A handful of states have waivers on funding Medicaid. People who are paying an arm and a leg for risk pool plans are bitching because they can't get in PCIP and those without PCIP can't afford the premium.
It got tabled but will be back on the radar again. The 1099 thing for businesses that buy $600+ in goods & services. That may not come back up during the lame duck session but you can bet it will come back once the new Congress is sworn in.
And this problem with carriers not wanting to insure kids stand alone won't go away either. Nor will all those MAP's that are going away and the PDP's.
And let's not forget the folks in DC are finally owning up to the fact they have no regulatory authority over the carriers and if the states don't want to play nice, well, Houston, we have a problem.
Sure am glad I didn't vote for that piece of crap legislation.
This is self destructing before it ever get's off the ground.
She was practically in tears when she called looking for something.
I really hate to get calls like that but nothing I can do.
No, I can't help everyone but I can sleep well at night knowing I have never recommended something I would not buy for myself or my family.
Vol is right. Mickey D was playing HHS like a fiddle and it worked like a charm.
Obamacrap is coming apart at the seams. The have now granted waivers to 30 companies and unions with mini meds. A handful of states have waivers on funding Medicaid. People who are paying an arm and a leg for risk pool plans are bitching because they can't get in PCIP and those without PCIP can't afford the premium.
It got tabled but will be back on the radar again. The 1099 thing for businesses that buy $600+ in goods & services. That may not come back up during the lame duck session but you can bet it will come back once the new Congress is sworn in.
And this problem with carriers not wanting to insure kids stand alone won't go away either. Nor will all those MAP's that are going away and the PDP's.
And let's not forget the folks in DC are finally owning up to the fact they have no regulatory authority over the carriers and if the states don't want to play nice, well, Houston, we have a problem.
Sure am glad I didn't vote for that piece of crap legislation.
This is self destructing before it ever get's off the ground.
- 8,448
Several Mini-Med News Reports dtd 10/8/2010:
Administration's Waivers Of Health Law Raise Questions About 'Mini-Med' Plans - Kaiser Health News
And a Mini-Discussion on the Pros & Cons of Mini-Meds:
Are 'Mini-Med' Plan Waivers A Good Idea? - Kaiser Health News
-AC
Administration's Waivers Of Health Law Raise Questions About 'Mini-Med' Plans - Kaiser Health News
And a Mini-Discussion on the Pros & Cons of Mini-Meds:
Are 'Mini-Med' Plan Waivers A Good Idea? - Kaiser Health News
-AC
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