Jeff Fowler
Expert
- 26
Does any know of the Cleveland Clinic providing its acceptance of Lasso or other MSA plans?
Lasso MSA
- Thread starter bpenn9
- Start date
I noticed in the Lasso agent material:
"MSA plans don’t have a network of providers, so members choose their health care services and providers. Many providers accept the MSA, including some of the largest and most renowned health systems. Providers can decide at every visit whether to accept the Plan and agree to treat a member, however, a member cannot be denied emergency care due to their insurance plan."
Has this been changed for 2021? Anyone know?
"MSA plans don’t have a network of providers, so members choose their health care services and providers. Many providers accept the MSA, including some of the largest and most renowned health systems. Providers can decide at every visit whether to accept the Plan and agree to treat a member, however, a member cannot be denied emergency care due to their insurance plan."
Has this been changed for 2021? Anyone know?
pretty sure that's always been true, somewhat like PFFS plans. Just mean an MD who accepts Medicare can say 'hey patient', I'ma bill you, & you can submit a claim for reimbursement from this Lasso outfit" -- which the beneficiary can do, and I believe that's what Lasso counsels in those probably infrequently occurring situations.
Jeff Fowler
Expert
- 26
I have done the recertifcation for Lasso and attended several of their web meetings. Here is the feeling I get after I listened to their information.
First, that plan designs look great! Plenty of value that would be enticing for clients and prospects to consider Lasso's value.
We all know that provider acceptance is key for any Medicare plan to be of value to anyone. That said, not having any provider network restrictions should be a great benefit. However, just because it Medicare's guideline, does guarantee that any particular provider is going to agree with that guideline. Many providers will accept Lasso and be willing to send claims to Lasso and know it is on a case-by-case or visit-by-visit basis.
Other providers don't agree with Medicare's guideline for various reasons. Some providers feel that it conflicts with in-network agreements with their other MA plans. This may or may not be a valid concern. It does not matter...
Why doesn't it matter? Well, it turns out that there is not any enforcement of Medicare's guideline for provider acceptance nor are they going to set up any system to enforce their MSA provider acceptance guideline. CMS has asked Lasso to tone back their marketing materials as far as provider acceptance statements. We will have to wait until October to see exactly what we have to work with.
I still like the MSA chassis Lasso is built upon and want it to work. However, I am taking extra care to explain the provider acceptance issue. The bottom-line, previous acceptance of Lasso does not mean it will continue for an particular member. So there is no such thing as "know ongoing acceptance".
If you are in a competitive MA market, like Arizona, then you have to consider how Lasso's value stacks up. We are going to have a lot of large-network HMOs and PPOs in the Phoenix market. Many of these are going to have very attractive plan designs without provider acceptance issue while in-network.
I feel I have to be sharper than ever this year.
First, that plan designs look great! Plenty of value that would be enticing for clients and prospects to consider Lasso's value.
We all know that provider acceptance is key for any Medicare plan to be of value to anyone. That said, not having any provider network restrictions should be a great benefit. However, just because it Medicare's guideline, does guarantee that any particular provider is going to agree with that guideline. Many providers will accept Lasso and be willing to send claims to Lasso and know it is on a case-by-case or visit-by-visit basis.
Other providers don't agree with Medicare's guideline for various reasons. Some providers feel that it conflicts with in-network agreements with their other MA plans. This may or may not be a valid concern. It does not matter...
Why doesn't it matter? Well, it turns out that there is not any enforcement of Medicare's guideline for provider acceptance nor are they going to set up any system to enforce their MSA provider acceptance guideline. CMS has asked Lasso to tone back their marketing materials as far as provider acceptance statements. We will have to wait until October to see exactly what we have to work with.
I still like the MSA chassis Lasso is built upon and want it to work. However, I am taking extra care to explain the provider acceptance issue. The bottom-line, previous acceptance of Lasso does not mean it will continue for an particular member. So there is no such thing as "know ongoing acceptance".
If you are in a competitive MA market, like Arizona, then you have to consider how Lasso's value stacks up. We are going to have a lot of large-network HMOs and PPOs in the Phoenix market. Many of these are going to have very attractive plan designs without provider acceptance issue while in-network.
I feel I have to be sharper than ever this year.
- 6,469
Caveat, not an agent.
I believe Lasso's Evidence of Coverage documents and plan information from other MSA plans currently on the market agree with gregj's comment.
Somewhere on the site are one or two posts from a consumer in another state (not AZ) that match the negative consumer experience some of jeff fowler's clients experienced in AZ.
On the other hand, Craig has posted somewhere that they had extensive legal review of their marketing materials (and note that here I am distinguishing between marketing materials and evidence of coverage documents) prior to their startup, and their attorneys believe Lasso's marketing materials are legally correct. (And there have been some posts about agents or agencies receiving help from the Lasso organization in resolving client conflicts with medical providers in regard to this issue.)
At the moment, it appears that each consumer and agent is going to have to make their own decisions about the MSA product risk in relation to this issue.
Just my opinions.
- 6,469
(To be clear here, I think the case by case basis is on the provider's part, not Lasso's part.)
You are correct.
- 6,469
Tell us how you really feel. haha
