how do you get back on original medicare

Dec 6, 2007

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  1. thewold
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    I have a client who is under 65 with a MAPD with Humana. Her doctors don't accept PFFS or any other MA plans so she wants to go back to original medicare. What are the steps to do this?
     
    thewold, Dec 6, 2007
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  2. GreenSky
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    All she needs to do is contact either Humana or Medicare. As of 1/1/08 she can be out.

    By the way, it's somewhat unusual for doctors (plural) to not accept a PFFS for any company. Are you sure they won't take it? They may think there is a network to join.

    Rick
     
  3. policy doctor
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    Actually, I had a Coventry Freedom client call me this week because her doctor posted no more Medicare Advantage accepted.

    He decided to go back to Original Medicare and Med supps only. Confused her.

    All I could figure out is that he was simplifing his practice, and didn't want to pay the billing clerks.
     
  4. MedSuppPro
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    What will she do when she gets back to Original Medicare? Will she qualify for a supplement?

    I would not rely on a phone call to the carrier. These situations require at lease a phone call to Medicare and a letter. A registered return receipt and photo copied, carefully worded letter.

    Yesterday, my client called 8 times to get through to somebody in Medicare who promised to process her request. She was reduced to tears. Her expectations of Medicare where shattered.

    Rick, sorry to brake ranks. I have numerous examples of hospitals and doctors whom are not accepting MA's and or specific carriers. Guess I should move to California.
     
  5. policy doctor
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    This particular client will have to change doctors in order to remain in a MA. a good start to find a doctor is go to medicare.gov to find doctors who take Medicare, and call the office to see if they're accepting new patients and Med Advantage.

    People have to be flexible if they enroll in these plans.
     
  6. GreenSky
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    Sorry to nick pick, but it's BREAK ranks, not BRAKE.

    However, out of 100 doctors, my guess is that 90 will accept these plans. And yes, I do know of many that won't, but the large majority will - especially if it's a known carrier. I've posted previously that a large medical group near me has decided to drop Pyramid because of claims issues but will accept Aetna and Secure Horizons. (They've asked me to do the educational seminars and enroll their patients - they will also be advertising the local newspaper. Ka-Ching!)

    That being said, I still think that PFFS will soon go the way of other good ideas that can't be executed properly. Although I never expected the designated hitter to last either.

    Rick
     
  7. MedSuppPro
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    10%

    Anecdotal Evidence

    For the former Pyramid members -- "10% is 100%"

    Attack the messenger -- GIVE ME A BRAKE!
     
  8. GreenSky
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    I didn't attack you at all, just pointed out that most doctors accept the plans. I didn't say I like PFFS plans but it's not quite as big a problem as many make it out to be.

    And yes, if MY doctor doesn't accept, then it is 100%. Maybe if companies like Pyramid actually had the ability to pay claims properly, this would not be an issue.

    Lastly, I pointed out it was my GUESS about 90%. If you have a better guess, go ahead and post it.

    Rick
     
  9. 2112Greg
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    The biggest issue with MA plans has been misrepresentation by douchebag agents...not the plans themselves. But that's another thread...

    Getting them back to original Medicare is pretty easy, but don't do it via phone call. I created a Word file that has the information the MA carrier requires to let them out of the MA plan (long story how I know about this). But fax that to the carrier, follow up with them to make sure they received it and they should be back to Medicare, generally, by the first of the next month.

    You can call Medicare, but I don't think that does anything. The carrier has a legal obligation to contact them within a certain period of time (can't remember what it is right now). If you want extra comfort, you can mail the same form, certified and with delivery confirmation, to make sure they got it.

    But that's basically it. Within the first 12 months of subscribing to an MA plan, they can change at will. After that, it's still possible...and not that hard, especially if the client feels they were misrepresented in the process of obtaining the MA plan.
     
  10. dandan
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    I still believe if you are in the senior business you are working yourself out of a job, selling MA's.

    Even in the Medicare& You it say the way to BUY a Med Advantage is Online or call the company direct.
     
    dandan, Dec 7, 2007
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