Lupron Prostate question

insurance5511

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Client takes it every 6 months to keep PSA levels down, has UHC now...Cant find anyone who would take him so far...any ideas thanx
 
So to ask a more helpful question:

Is he in remission?
If so, how long?

Honestly though, it’s going to be really hard to find a provider for someone that’s taking chemo, even maintenance
 
Not saying it is impossible but typically it would be difficult to find a plan G from any carrier at a lower cost than plan N as plan N does not offer as many benefits as G. The underwriting would also be an issue as has been said.

I’m just throwing this out there:

There’s no reason to talk about plans if you can’t pass underwriting. I think ops question was really would anyone take him.
 
I’m just throwing this out there:

There’s no reason to talk about plans if you can’t pass underwriting. I think ops question was really would anyone take him.

Right, which is why I asked what type of plan he was on and what he was looking for. He could get a Medicare Advantage plan during enrollment if that was what he was looking for but it is not.

But it is good to know about price differences between plan G and N. Really, he is looking for the improbable even without underwriting so to say that up front saves time from trying to find that magic carrier that might take him.
 
Right, which is why I asked what type of plan he was on and what he was looking for. He could get a Medicare Advantage plan during enrollment if that was what he was looking for but it is not.

But it is good to know about price differences between plan G and N. Really, he is looking for the improbable even without underwriting so to say that up front saves time from trying to find that magic carrier that might take him.

Yeah, your assessment is weird to me. Who cares if Plan N is cheaper than Plan F if you can’t get it?

Also, in this instance, if dude even brought up MA he’d be referred out immediately. That seems like something that would get you in a bit of trouble w/ CMS when he inevitably complains.
 
Yeah, your assessment is weird to me. Who cares if Plan N is cheaper than Plan F if you can’t get it?

Again, the first step was to find out what he was looking for. He brought up Plans N and G and I was just explaining further for the agent's knowledge. It is something they should know for the future.

Also, in this instance, if dude even brought up MA he’d be referred out immediately. That seems like something that would get you in a bit of trouble w/ CMS when he inevitably complains.

Not if the client was asking about MA. Then the agent just fills out the SOA because he was approached and not the other way around. Believe it or not, I have met agents who somehow don't realize (or forgot and had a brain lapse) that MA is Guaranteed Issue (in many cases).
 
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Again, the first step was to find out what he was looking for. He brought up Plans N and G and I was just explaining further for the agent's knowledge. It is something they should know for the future.



Not if the client was asking about MA. Then the agent just fills out the SOA because he was approached and not the other way around. Believe it or not, I have met agents who somehow don't realize (or forgot and had a brain lapse) that MA is Guaranteed Issue.


MA is not guaranteed issue. There are limited reasons why you’d be rejected, but ESRD and ALS are two of them.

ERSD could be overcome with Special Needs or an exception. Also,

Also, moving a client from Med Supp to MA under Chemo treatment? You think he’s not going to complain when he tries to use his MA and finds out the costs? Okay.

Also, you asked why he was wanting to move and who he was with. The original question is who would approve him.

Rates don’t matter if you don’t health qualify.
 
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