MAPD question

[rawlan]

I have a client that went on company A against my recommendation. He now wants to switch to another MAPD carrier, but he is in the hospital and will be going to an inpatient rehab facility in a couple of days. If he switches to the company I recommended in the beginning while he is in the rehab facility will the benefits start over 20 free days? And would he have to get another pre-authorization?

Thanks in advance

 

[vic120]

No nothing gets reset its always by calendar year, Yes He may have to get preauth but if its legit should be no problem

The only concern is I know if he lived there he would not be able to purchase they have nursing home plans in many area's too

But It at least was and probably still is a question on the MA App

 

[rawlan]

Thanks for the response.

Just to clarify, he is not in a nursing home, it is an inpatient facility for physical rehab. He will be in there for about 35 days. The first 20 days are covered, but days 21-100 he has a daily copay. If he switches MAPD plans do the days 1-20 start over?

 

[vic120]

Thanks for the response.

Just to clarify, he is not in a nursing home, it is an inpatient facility for physical rehab. He will be in there for about 35 days. The first 20 days are covered, but days 21-100 he has a daily copay. If he switches MAPD plans do the days 1-20 start over?

Sorry skim-reading he should be good then

 

[TwoCents]

No nothing gets reset its always by calendar year, Yes He may have to get preauth but if its legit should be no problem

The only concern is I know if he lived there he would not be able to purchase they have nursing home plans in many area's too


But It at least was and probably still is a question on the MA App

What the what? There are no disqualifiers for MA enrollment. Even ESRD has gone the way of the dodo!

 

[policywunk]

I have a client that went on company A against my recommendation. He now wants to switch to another MAPD carrier, but he is in the hospital and will be going to an inpatient rehab facility in a couple of days. If he switches to the company I recommended in the beginning while he is in the rehab facility will the benefits start over 20 free days? And would he have to get another pre-authorization?

Thanks in advance

No it wont start over and he wont get credit for his hospital stay copays towards the new plan MOOP.Yes a new authorization is needed but carrier may have a continuity of care form you can complete to speed out the process. Be careful with this one especially if SNF is not in network on new plan.I wouldn't touch it.

 

[Millwood]

No it wont start over and he wont get credit for his hospital stay copays towards the new plan MOOP.Yes a new authorization is needed but carrier may have a continuity of care form you can complete to speed out the process. Be careful with this one especially if SNF is not in network on new plan.I wouldn't touch it.

Awww it'll give you a great chance to try your E&O out.
This type of client doesn't listen to anyone. Then they want you to bail them out of THEIR mess. Then they'll be the first to come after you if it doesn't work out. Nine times out of Ten the clients you do the most for appreciate it the least.