Help me solve this problem!

[Newby]

Had not considered that angle, but it makes more sense than other speculations.

OM is simple to administer on the provider side and OM/Medigap generally pay quicker than MA plans . . . so why would a provider want to limit the practice to managed care and cash only?

Just like an addicted gambler or drinker. He can't keep his hands out of the cookie jar if unmonitored and he doesn't want to go to jail. He's trying to clean up his messes and get off the radar.
That's the only possible reason I can think of. Could be way wrong of course.

 

[somarco]

He can't keep his hands out of the cookie jar if unmonitored and he doesn't want to go to jail.

Doesn't sound like the kind of shop you would want to deal with if commission is flowing through his shop.

I used to work with TPA's that managed self funded group plans. There were ways to skim money . . . as long as they didn't get too greedy they had a nice income stream.

 

[Chazm]

I would have to assume the doctor is being suspected of Medicare fraud or something and is trying to get off the radar.

MA only doctors aren’t new. The Villages in FL have a lot of doctors that don’t accept Medicare but accept UHC MAPD.

 

[Todd King]

My wife and I are on Traditional A&B with a plan G supp. My wife has a pretty severe case of fibromyalgia, and is under care of a pain management practice. Because her pain meds are controlled, she’s required to see them for an office visit once a month. This evening, we received the following letter in the mail (dated 11/20 but envelope not postmarked until 12/6!):

We are writing you to let you know our NEW Office Policy for 2024 that will be going into effect as of January 1st, 2024. To all our patients who are currently Traditional Medicare Members (Red, White & Blue Card) as of December 31 2023 we will NOT be renewing our contract in 2024 with Traditional Medicare. That means that you will either have to get a Medicare Replacement Card or become a Self Pay/Cash payer to remain with us.

If you decide to be a self pay patient you will be responsible for $150.00 per visit that is due at time of service. For those of you who decide to switch to a Medicare Replacement Card for 2024 we are in contract with most Medicare Replacement Plans. Should you have questions….yada yada….

As ticked off as we both are about this, my wife would rather not have to find another clinic. So we’re in a bit of a dilemma. I’m assuming “Medicare Replacement plans” means Med Advantage, correct? AEP just ended on 12/7, correct? SO… we might have considered switching to MA if AEP had not just ended THE DAY BEFORE WE GOT THE LETTER!
If they had mailed it out within a day or two of the date on the letter itself, we wouldn’t be having this problem!!!

I never wrote much MA, and it’s been long enough ago that there was no AEP at that time. So I don’t know if there’s a way around the deadline. Would there be an exception in a case like this or are we just stuck until next AEP?

Just my opinion, but you really should try your best to talk your wife into finding a new doc. In the end, she'll be glad she did. Either that or see if you can get an MA plan and then next year, when she's tired of jumping through hoops....she can use her trial right.

 

[shonceman]

Just my opinion, but you really should try your best to talk your wife into finding a new doc. In the end, she'll be glad she did. Either that or see if you can get an MA plan and then next year, when she's tired of jumping through hoops....she can use her trial right.

Thanks, Todd. We did find another doctor. When it came down to it, all the same reasons for not choosing MA to begin with still applied. We had determined that we’d just pay the $150 per visit until we could switch doctors. But, after calling several, we found another doctor that was able to get her scheduled for the second week in January.

I appreciate everybody’s helpful insights on this!

 

[agentjhc]

My wife and I are on Traditional A&B with a plan G supp. My wife has a pretty severe case of fibromyalgia, and is under care of a pain management practice. Because her pain meds are controlled, she’s required to see them for an office visit once a month. This evening, we received the following letter in the mail (dated 11/20 but envelope not postmarked until 12/6!):

We are writing you to let you know our NEW Office Policy for 2024 that will be going into effect as of January 1st, 2024. To all our patients who are currently Traditional Medicare Members (Red, White & Blue Card) as of December 31 2023 we will NOT be renewing our contract in 2024 with Traditional Medicare. That means that you will either have to get a Medicare Replacement Card or become a Self Pay/Cash payer to remain with us.

If you decide to be a self pay patient you will be responsible for $150.00 per visit that is due at time of service. For those of you who decide to switch to a Medicare Replacement Card for 2024 we are in contract with most Medicare Replacement Plans. Should you have questions….yada yada….

As ticked off as we both are about this, my wife would rather not have to find another clinic. So we’re in a bit of a dilemma. I’m assuming “Medicare Replacement plans” means Med Advantage, correct? AEP just ended on 12/7, correct? SO… we might have considered switching to MA if AEP had not just ended THE DAY BEFORE WE GOT THE LETTER!
If they had mailed it out within a day or two of the date on the letter itself, we wouldn’t be having this problem!!!

I never wrote much MA, and it’s been long enough ago that there was no AEP at that time. So I don’t know if there’s a way around the deadline. Would there be an exception in a case like this or are we just stuck until next AEP?

Is there a 5* plan in your area?

 

[shonceman]

Is there a 5* plan in your area?

There is one under UHC, but we’re going to stick with OM + supp, now that we’ve found a specialist that will accept it.

 

[somarco]

There is one under UHC, but we’re going to stick with OM + supp, now that we’ve found a specialist that will accept it.

You do realize some agents on the forum (not me) are shaking their heads in disbelief at how you can willingly pay a premium when you could have $0 premium . . .

Don't be surprised if you get a PM from some of these agents who will try and pry that cash out of your hands so it can be invested in products indemnity products like hospital indemnity, cancer . . .

 

[Packerland]

MA only doctors aren’t new. The Villages in FL have a lot of doctors that don’t accept Medicare but accept UHC MAPD.

The Villages is a great example..I had a husband and wife couple they had med supplements and I told them that they needed to get an advantage plan from The Villages if they wanted to use their doctors. They insisted they were okay and wanted to keep this supplements and within 6 months they called me and enrolled into UHC Village's MA plan the following year.

 

[axeman462]

The Villages is a great example..I had a husband and wife couple they had med supplements and I told them that they needed to get an advantage plan from The Villages if they wanted to use their doctors. They insisted they were okay and wanted to keep this supplements and within 6 months they called me and enrolled into UHC Village's MA plan the following year.

There's even more a little west of TV along the Nature Coast. A large practice with several locations (can't think of the name of it at this exact moment), that about half the doctors in the practice do not accept OM.
My understanding is that over the next few years, the entire practice will be MA only.

I've said it several times on this forum, but the MSOs mock. This is a trend that will gain momentum in the future, as OM payments get cut to the doctors.