Manhattan (CUL) Adds netword to Dental, Hearing, Vision

[LostDollar]

I'm a broker in Kansas....when I run the Manhattan zip code in the agent portal I see more plans than you are apparently seeing, but if you're not in NE KS then plans might be different. If you want to message me your zip I can see what I get on my end.

I'm not sure why the difference between the allowed amount and billed would be the responsibility on a pre-d if the dentist is in-network...UHC should be indicated that the provider writes that off. Something sounds off

I have seen something in passing about Kansas passing a bill that says dentists do not have to accept network caps for services that the insurance carrier does not cover.

I had not seen that information then, but the first place I hit against that was floride varnish. Delta Dental did not cover adult flouride varnish, but they had a code and a cap for it. So each visit I would see my (old, now retired) dentist writing off 5-6 dollars to bring his charge down to Delta's allowed amount.

UHC also does not cover adult flouride varnish, but they do not have a code or a cap for it, so each eob, I would see the dentist's full charge carrying through for me to pay-an additional 5-6 dollars a visit beyond what happened when I had Delta.

The same thing is now going on with the filling. This pre determination was issued to/for a different dentist than the one I will be visiting to get the work done, but:

Service code D2391 showing the dentist's charge, my deductible, amount (to be) paid, and my responsibility. EOB code is K96.

K96 Alternate benefits applied. The patient is responsible to pay the diff erence between an amalgam restoration and the posterior composite.

(And preceding the filling code detail there are 3 lines.
The first one has my name and member number.
The second states "In Network". )

So, regardless of what I think about it, this appears to be the way it is going to work.

 

[myinsurebiz]

Are you appointed (running these in e-Store) or just going to their site?

Dollar isn't an Agent . . .

He just likes hanging out with Agents.

 

[goillini52]

I had some reservations about the value of CUL (to me) a couple of years ago. My concerns are a little higher now. First there was the switch to reasonable and customary, from full charges, for new enrollees.

And then all of chazm's posts. I don't think he has any reason to lie about his client's experiences and when I read his posts, it is like he is describing an entirely different insurance carrier than how you and rousemark describe CUL.

I just checked my UHC policy and it also is only paying 50% on major services. However, in year one, it only required a 4 month wait, rather than 6 or more to start routine preventive services. MY preventive work each year (unlike some with better dental health) requires an annual bitewing exray set in addition to cleanings and exams. The sales literature suggested, but did not promise, that I might have better network caps with UHC than some other carriers.

When I considered all those items as a whole, in relation to the premium, I thought it would work. Not sure where I came out the first year, but last year I'm pretty sure that I got back my premiums in a combination of amounts paid to the dentist and writeoffs. Not sure how it will work going forward, but I am not yet at the point where I personally would consider CUL a viable alternative to what I have now.

To each his own. The more CHBS revealed, the more convinced I am that Manhattan is a better plan.

 

[LostDollar]

To each his own. The more CHBS revealed, the more convinced I am that Manhattan is a better plan.

I would expect no less from you. You have been sold on CUL from the start.

 

[CHBS]

I have seen something in passing about Kansas passing a bill that says dentists do not have to accept network caps for services that the insurance carrier does not cover.

I had not seen that information then, but the first place I hit against that was floride varnish. Delta Dental did not cover adult flouride varnish, but they had a code and a cap for it. So each visit I would see my (old, now retired) dentist writing off 5-6 dollars to bring his charge down to Delta's allowed amount.

UHC also does not cover adult flouride varnish, but they do not have a code or a cap for it, so each eob, I would see the dentist's full charge carrying through for me to pay-an additional 5-6 dollars a visit beyond what happened when I had Delta.

The same thing is now going on with the filling. This pre determination was issued to/for a different dentist than the one I will be visiting to get the work done, but:

Service code D2391 showing the dentist's charge, my deductible, amount (to be) paid, and my responsibility. EOB code is K96.

K96 Alternate benefits applied. The patient is responsible to pay the diff erence between an amalgam restoration and the posterior composite.

(And preceding the filling code detail there are 3 lines.
The first one has my name and member number.
The second states "In Network". )

So, regardless of what I think about it, this appears to be the way it is going to work.

 

[LostDollar]

I see you're in Kansas, I ran 66502 in the agent portal and got 4 Gen (senior) plans and when I did a u65 DOB, I got 6 options.

(sorry, I may not have put this on previous posts, I don't always remember, goillini and some of the others know.
Caveat, not an agent.)

Thank you. Now I'm connecting with "gen" senior.

when I use a 75 dob I get the 4 gen plans. When I use some younger ages I can get 10 or 14 depending on the age. (uhone, request a quote, consumer screen.)

 

[CHBS]

@LostDollar - I'm definitely going to have to research what you mentioned about KS not requiring dentists to accept network rates. That negates carrier contracts (at least the key value of ). To be honest, I do not market in Kansas because the KS DOI is so anti insurance companies that they cause more damage than good. There is so little (product) to choose from. States like Colorado have far stricter overall insurance restriction, but they don't make it impossible. I, of course, have several KS clients but it's federally only. I dislike the being so limiting in how I can build a solution that fits their needs, especially when I know what is available in every surrounding state. (I get envious often of my own clients...I want the insurance I am able to enroll them in!!) I shall step off the soap box now...

I'm impressed with your savviness! With the level of detail you presented, i would only be able to provide a helpful response if I could see UHC's claim system and see how your pre-d processed, which I obviously cannot. It still sounds wrong to me that they are basically telling the provider that they can balance bill you (charge you the difference between allowed and charged)..:hopefully your claim will not process that way. I would be interested in hearing the final outcome.

Kudos on informing yourself and being able to advocate for yourself. It's necessary!! I spent almost an hour convincing my eye doctors office yesterday that they over charged me $78 after making three separate errors on the claim and interpreting the benefits. I made every one of the points at the time of service and they refused to listed. ‍‍‍ I told them I wasn't even mad, but they really need to improve their understanding of benefits AND level of service because ALL of the mess could have been avoided if the lady would have just listened to me last week. My point is..if you aren't in top of it you will pay (liteally!).

 

[CHBS]

I

Dollar isn't an Agent . . .

He just likes hanging out with Agents.

figured that out! lol! Where can I find informed, self-sufficient clients like him?!

 

[LostDollar]

AAPD | Non-Covered Services Laws by State

The Kansas section in that table is what I was talking about. It is extremely confusing to me trying to read it, but I think that would be the justification for a dentist in network with my UHC plan having to accept a network cap for a resin filling done on an anterior tooth, but not having to accept a network cap for a resin filling done on a posterior tooth.

edit------
and an article
Defined Dental Benefit Plans: Can They Limit the Fees of Non-Covered Services? - Spear Education
end edit-------

edit again------
another article
Is it a covered benefit? Understanding the noncovered services law

And my UHC predetermination EOB, when compared to the crown example in the article, seems to suggest the the UHC/dentist contract excludes capping of the non-covered service.

I'm getting my tooth fixed tomorrow. I'll let you know how UHC and the dentist process the claim.
end edit--------

 

[Senior_Ins]

Looks very similar to the Aetna product...Careington Network, pool of money concept for D, V & H.

Does this plan offer the same discounts on D, V & H as Aetna's?