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Playing the "what if" game along with "I know people who" is mostly meaningless until you (your client) is the one with a surprise diagnosis.

One of the first people I wrote when I switched to Medigap was a guy in supposedly perfect health. Non-smoker, not overweight, played tennis 2x per week.

A few months after going on Medicare he had a massive heart attack . . . while playing tennis with his cardiologist . . . the same one who gave him a complete physical including stress test a week earlier. He was dead before he hit the court.

Another client, also in good health, really wanted a Medigap but he could not afford the premium. He also had several docs and fitting him into a MAPD would have been a challenge, so he bought an HDF. Six months later his health changed, admitted to the hospital several times over the next few months . . . bills well over $100,000 but his HDF with a $45 premium kept his OOP under $2,000.

Over the next few years he has had multiple doc and hospital bills and it has been rough financially but he is glad he has the policy.

I know a number of folks who were very healthy until they were not. The only thing that really matters is this. Will the policy you have pay out or not.

Medicare and Medigap always pay, no hassles, no appeals. Rock solid.
 
Playing the "what if" game along with "I know people who" is mostly meaningless until you (your client) is the one with a surprise diagnosis.

One of the first people I wrote when I switched to Medigap was a guy in supposedly perfect health. Non-smoker, not overweight, played tennis 2x per week.

A few months after going on Medicare he had a massive heart attack . . . while playing tennis with his cardiologist . . . the same one who gave him a complete physical including stress test a week earlier. He was dead before he hit the court.

My situation was similar.. went to bed one night with no problems. Got up the next morning with a knot on the side of my neck. Throat cancer already developed into stage 4 (there is no stage 5).. Just becasue your client is healthy today does not mean they will be tomorrow.
 
Well it’s one against 10 here so I will stop trying to make points. Obviously not going to change any of your minds and don’t really care if I do or not. I have over 500 on MAPD and I have had 2 meet their max OOP since 2008. They had GTL hospital plans like 80% of my MA clients do so it didn’t all come out of their pocket.

i guess being in the Midwest I am just lucky because plans are really good and have 0 issues with Dr or Hospital networks. I also have the Medica Cost Plan to fall back on without health questions which is better then a Med Sup also. Some day hopefully you will see that OM approving every procedure and physical therapy in SNF is not a good thing and bites the clients in the *ss with rate increases.
 
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?

Unfettered access to care does not exist in the managed care world . . . at least the one I have dealt with for over 30 years.

There is the ever present pre-authorization for tests and/or procedures. Doc says you need it, carrier says you don't.

If an agent is selling MAPD in a universe where only 2 out of 500 people ever maxed out their coverage it is probably because a number of policyholders died while waiting on approval and did not have time to max out the plan.


https://patientengagementhit.com/news/91-of-docs-say-prior-authorization-delays-patient-care-access

https://getreferralmd.com/2018/04/prior-authorization-problems-healthcare-2/

What is prior authorization? | Cigna

Measuring the Scope of Prior Authorization Policies
 
No doubt there are some that need it but when I see them wheel alzheimers patients into speech, physical and occupational therapy 3x a week and they don't even wake up then I have a problem with it. Or wheel them in and have them play with play-doh for 45 minutes and charge $200. It's called milking the system because they can get away with it.
 
No doubt there are some that need it but when I see them wheel alzheimers patients into speech, physical and occupational therapy 3x a week and they don't even wake up then I have a problem with it. Or wheel them in and have them play with play-doh for 45 minutes and charge $200. It's called milking the system because they can get away with it.
I prefer to choose what kind of care I get(Med Supp), instead of leaving it up to someone with your outlook(MAPD Preauthorization).
 
Unfettered access to care does not exist in the managed care world . . . at least the one I have dealt with for over 30 years.

There is the ever present pre-authorization for tests and/or procedures. Doc says you need it, carrier says you don't.

If an agent is selling MAPD in a universe where only 2 out of 500 people ever maxed out their coverage it is probably because a number of policyholders died while waiting on approval and did not have time to max out the plan.


https://patientengagementhit.com/news/91-of-docs-say-prior-authorization-delays-patient-care-access

https://getreferralmd.com/2018/04/prior-authorization-problems-healthcare-2/

What is prior authorization? | Cigna

Measuring the Scope of Prior Authorization Policies

Yep, the rest died on the table with the Dr. ready to cut open their chest. You are a bright one. Have no idea what you are talking about. Keep those blinders on.
 
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