If You're a Cop You Have to Tell Me, Are You a Cop?

[sshafran]

Yes, I'm aware as is CMS. But at least one agent on this forum was adamant that MAPD's didn't cover cataract surgery. But he claims to be smarter than CMS on his dumbest days.

Is it the same agent who was asking us for advice on what to do about his dad's MAPD plan?? #DarnAetna

 

[bpenn9]

I wonder if CMS knows whether or not MA plans cover cataract surgery?

Hilarious.............................

 

[Bob_The_Insurance_Guy]

Is it the same agent who was asking us for advice on what to do about his dad's MAPD plan?? #DarnAetna

Yes, if the opthamologist is not on the PPO or HMO MAPD Plan, the plan will not cover the surgery. We already have been through this. Thanks for holding on tight to this. One day, you must show us how you walk on water.

Thanks for the mature response. Must be nice to never make a mistake. Of course you can't find where I clarified that part. That would take humility on your part, and you are nothing but a prick.

 

[sman]

Yes, if the opthamologist is not on the PPO or HMO MAPD Plan, the plan will not cover the surgery. We already have been through this. Thanks for holding on tight to this. One day, you must show us how you walk on water.

Thanks for the mature response. Must be nice to never make a mistake. Of course you can't find where I clarified that part. That would take humility on your part, and you are nothing but a prick.

Clarified? Here's what you said:

...Now, I also sell Medicare Supplements, and can give you several examples where they are a better fit. I am just as passionate about Medicare Supplements.

For someone who needs cataract surgery, they are a MUST!

When someone then asked you why they are a MUST if you need cataract surgery you responded with:

Medicare Advantage Plans do not cover cataract surgery. That's why.

After MULTIPLE people corrected you, you came back with your clarification statement about many of your clients eye doctors aren't in the network and you didn't type everything you were thinking. To that I say, it's up to us to find out which doctors our clients see and make sure they are in the network of whatever plan we recommend.

You later went on to say this:

This is me responding.

In all 4 cases in the past two years, the eye surgeon that my clients wanted to use was not in network. Since all 4 happened to be on HMO MA Plans, then my narrow view was that MA will not cover, ESPECIALLY if the eye surgeon is not in network.

So first you say that it isn't covered. Then you say you meant to say it was based on network. Then you say "my narrow view was that MA will not cover...".

You can call us pricks all you want. But when you're out there advising seniors and potentially telling them that MA doesn't cover cataract surgery, you better believe we are going to hold you accountable. Had you not made the comment about being smarter than CMS on your dumbest day then this probably wouldn't have come up.

Here's the link to that thread in case anyone needs to see that I'm not making any of this up.

http://www.insurance-forums.net/forum/senior-insurance-forum/sneak-peaks-rumors-t66869-3.html

 

[sshafran]

Yes, if the opthamologist is not on the PPO or HMO MAPD Plan, the plan will not cover the surgery. We already have been through this. Thanks for holding on tight to this. One day, you must show us how you walk on water.

Thanks for the mature response. Must be nice to never make a mistake. Of course you can't find where I clarified that part. That would take humility on your part, and you are nothing but a prick.

So PPO's decline out-of-network benefits for cataracts?

How many people do you say these things to?

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So PPO's decline out-of-network benefits for cataracts?

How many people do you say these things to?

Next time you get one of those letters or e-mails from people ready to work with you - perhaps you should refer them out to someone who knows how insurance works....

 

[kstein]

I don't agree with a lot of what was mentioned here I will say that PPO plans often don't work for out of network for any services when the provider is not in the PPO network. Just ask all those doctors in Florida or St. Louis that uhc dropped if they would accept the UHC PPO. Even though it says on paper you can access oon benefits, it doesn't work like that all the time in the real world.

 

[Thad.Sipple]

100% of my Medicare business is referral from Investment Advisors, CPA's and Elder Care Attorneys. All of them know to have the person(s) contact me via letter or email, stating who they've spoken to, and that they want to talk with me about their Medicare options. ..."and, oh, by the way, here are the doctors I see and the medications I take..." I then send them a SOA, get it filled out, then call for an appointment. I do not accept phone calls from someone who wants to work with me. It MUST be either an email or letter, referring to the individual who they talked to. On CMS's smartest day, they are not as smart as I am on my dumbest day People must know me, like me, and trust me, before they work with me. This is one way that I ensure a Medicare Beneficiary wants to work with me. It only works for me. I don't expect it to work for the rest of you.

You must be one rich mofo. I envy you, to have potential clients contact you via letter, is strong. What type of jaguar do you drive?

 

[Glen Shelton]

You must be one rich mofo. I envy you, to have potential clients contact you via letter, is strong. What type of jaguar do you drive?

^^^

Are you kidding Thad???

You think this guy would drive his own car! He sits in the back while his chauffeur drives

 

[Bob_The_Insurance_Guy]

You are right.

I am wrong.

I do not know what I am talking about, and you do.

By the way, I drive a Kia Sorento.

Obviously, if I ever said anything worthwhile, I am sure you would have found it. Since you have not, then that is proof enough that I have nothing to add to this forum.

Bless you, dear lord, savior of all people.

 

[bill3173]

Ever take the time to go to people's houses if they are very evasive on the phone? Doesn't sound like a promising start to having a new client.

She may be evasive, just to get you to agree to "see her". I have one of those that has been one of the biggest pita as a client. She became Medicare eligible in her early thirties. She always wants to see me in person for everything. I told her last year that I didn't have time. She pitched a fit, but I still didn't go to see her. This year, she contacted another agent, that basically told her to take a hike, so she came back to me a little calmer than before and willing to listen.

No big surprise, but mental health issues got her into Medicare, and whatever treatment she's receiving is obviously not working. You may dodge a bullet by taking a pass on this one.