Gosh, I would prefer to take my doctors recommendation of care, vs an insurance company dictating what treatment is allowed.
And last I heard, doctors can move in and our of network each year. That would suck if I had a serious health condition.
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Gosh, I would prefer to take my doctors recommendation of care, vs an insurance company dictating what treatment is allowed.
And last I heard, doctors can move in and our of network each year. That would suck if I had a serious health condition.
If you live in a GI state, or birthday/anniversary rule state, that approach might work . . . otherwise it is just a trick like using the "free look" close
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There literally is no argument when you compare access to treatment w/ MAPD and Medigap. Straight from OIG, 4 years apart.. nothing is different.
https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf
Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials Report (OEI-09-16-00410) 09-25-2018
Good news... they overturn 75% of denials.. Nothing like holding off treatment or paying out of pocket in hopes for reimbursement because you have to go through the appeals process to get the services you're entitled to under Medicare.
But, just fear-mongering... no government studies to back that up. ::eyeroll::
https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf
Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials Report (OEI-09-16-00410) 09-25-2018
Good news... they overturn 75% of denials.. Nothing like holding off treatment or paying out of pocket in hopes for reimbursement because you have to go through the appeals process to get the services you're entitled to under Medicare.
But, just fear-mongering... no government studies to back that up. ::eyeroll::
Give an example of "false information" from agents selling Medigap.
Are you suggesting that agents selling MAPD are completely transparent about things like non-par providers, pre-authorization, claim delays and denials, referrals, OON OOP . . . etc.?
Read my post, I'm speaking about the health care treatment the doctor advises, without the insurance type or company coming into the equation.
Example. Doctor says i don't like the looks of that lump, u need an MRI now. Insurance company disagrees and delays or declines the pre auth. Who is right? I would hate for the delay to cause harm to my client or myself.
It's already an issue with drug plans, and pre auth. Why expand it and include doctors and caregivers?
It always gets me when agents ever so casually say "Just appeal it". Like everyone has the time, expertise and ability to appeal claim denials.
And don't say it is up to the provider to appeal. They don't have the time or staff to appeal claim denials.
Also, MAPD plans are not included in ABN protections.
- 4,200
I don't know how MAPD plans work in regards to processing time... but SSA Disability (for the client) is a real pita. When I would review appeals, it would start from the beginning of the case and work forward. Granted, that's more in-depth, but it's really dishonest of agents to sell that access to care isn't a major issue in MAPD.
It's not JUST provider access. It's getting shit paid.
Just a question for MAPD pushers (and I don't mean people that offer MAPD, I'm talking about PUSHERS)
If the insurance company refused to pay you 18% of the time, and you had to appeal to money you were entitled to, would you keep offering that company?
If not, why would you actively throw your clients into the same bus?
"Because they can't afford better medical coverage?" Bullshit.
"Because I get paid more?" Bingo.
Again, I don't hate the concept of MAPD, but in the framework of Medicare and how it works? It's definitely not my first choice.
That might mean I get paid 10 dollars a month for HDG+PDP, but is the client ultimately better off? Yep.
(Considering the claims that HDG ends up paying out.. they could increase the commission a bit though...)
I wonder why they won't spend a billion on med supp market? Profit margins may be the answer.
"Humana is moving forward with its plan to invest $1 billion into its Medicare Advantage business, executives said during an earnings call Wednesday."
Humana records $930M quarterly profit as Medicare Advantage rolls grow 5%
"Humana is moving forward with its plan to invest $1 billion into its Medicare Advantage business, executives said during an earnings call Wednesday."
Humana records $930M quarterly profit as Medicare Advantage rolls grow 5%
There will be 80 million people on Medicare by 2030. Even if we reach 70% on MAPD, that still leaves a large number for Med Supp. There is plenty of room for both products. I know you may not believe this, but there are actually some Medicare beneficiaries who prefer a Med Supp over a MAPD.
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Caveat, not an agent.
I don't see that as much different than insurance agents having concerns about the commission levels of products they sell.
