- 11,280
I meant to say most plans, not all. United World, Admiral, and sterling all took the same increase across the board.
Med Supps
- Thread starter MOHEALTH
- Start date
I meant to say most plans, not all. United World, Admiral, and sterling all took the same increase across the board.
- 7,066
Ricky, Ricky, Ricky.
Remember, we NEVER take another agents word for anything without checking it out ourselves. "Checking it out" does not constitute asking another agent regardless of who it is.
This is a prime example. I believe I'm right, you believe Craig over me. Newby doesn't know and is guessing. Retread thinks it is okay but the chances of using it are slim, and can not be justified on a risk basis.
Tomorrow morning I'm going to do what we all should have done earlier and that is call an insurance company. The underwriting dept should be able to tell us exactly what they will pay for and what they won't and when the benefit can be used.
Why don't you and Newby do the same and we can all report back here and let's find out once and for all exactly what it is, when it can be used and what it can be used for.
Since we are all working in the senior market and attempting to explain this benefit to prospects I think it is incumbent on us to, know what the hell we are talking about.
- 11,280
You guys call the insurance company and I will call Frank at noon. I will then report what Frank told me. 
Could you also ask the underwriter if the At Home Recovery is payable if you do not own a home and if you have to be in your own home to recieve the benefits. We need to clarify if a trailor is considered a home also.
Could you also ask the underwriter if the At Home Recovery is payable if you do not own a home and if you have to be in your own home to recieve the benefits. We need to clarify if a trailor is considered a home also.
- 7,066
You guys call the insurance company and I will call Frank at noon. I will then report what Frank told me.
Could you also ask the underwriter if the At Home Recovery is payable if you do not own a home and if you have to be in your own home to recieve the benefits. We need to clarify if a trailor is considered a home also.
That is a excellent question. I'm bad for not thinking of it.
No wonder you are "making the big bucks". When I grow up I want to be just like you.
- 11,280
You do not know how many times I have heard that.
I wanna be, I wanna be, I wanna be like Mike.
- 7,066
I find it interesting that you apparently believe you know the answer and have documentation to support your answer but were not considerate enough to share it with us.
That sounds like the kind of answer one would get from a manager. Immediately changing the subject is another technique used by people who want one to believe that they have the correct information but aren't sure themselves.
- 7,066
At Home Recovery as definied by Continental Life in their Med Supp policy Plan D.
I called Continental Life this morning and this is what I found out.
No one at Continental was able to give me a definitive answer or refer me to any documentation. I spoke to two people in Marketing, one in Claims and two in Policy Holder Services. I found it interesting that they were all giving me their "opinion" and each had something different to say.
I think that it is interesting that none of them had a copy of an actual policy handy nor did they attempt to get one and read the section explaining At Home Recovery.
I remembered that I had a copy of a Continental Life Med Supp policy, Plan D, in my file cabinet and took it out and went to the section explaining At Home Recovery.
The policy states:
Definitions
For the purposes of this benefit the following definitions shall apply.
Activities of Daily Living: include, but are not limited to bathing, dressing, personal hygiene, transferring, eating ambulating, assistance with drugs that are normally self-administered, and changing bandages or other dressings.
It goes on to say:
...Care furnished on a visiting basis in Your home and by a care provider as defined by Medicare...
...Your attending physician must certify the type and frequency of the services that are necessary because of a condition for which a home care plan of treatment was approved by Medicare...
...Services must be received during the period You are receiving Medicare-approved home care services or no more than eight (8) weeks after the service date of the last Medicare approved home health care visit;
Benefits are not payable for home care visits paid for by Medicare or other government programs; nor for care provided by family members, unpaid volunteers or providers who are not care provider...
It still sounds like At Home Recovery is a benefit that is an extension of Home Health Care since it can be used after the last Medicare Home Health Care visit.
If in fact my clients who have received Home Health Care have told me ADL's were provided during regular Home Health Care visits. So, being able to continue help with ADL's after home health care terminates would probably be the most often requested reason for a claim for the benefits provided by At Home Recovery.
I called Continental Life this morning and this is what I found out.
No one at Continental was able to give me a definitive answer or refer me to any documentation. I spoke to two people in Marketing, one in Claims and two in Policy Holder Services. I found it interesting that they were all giving me their "opinion" and each had something different to say.
I think that it is interesting that none of them had a copy of an actual policy handy nor did they attempt to get one and read the section explaining At Home Recovery.
I remembered that I had a copy of a Continental Life Med Supp policy, Plan D, in my file cabinet and took it out and went to the section explaining At Home Recovery.
The policy states:
Definitions
For the purposes of this benefit the following definitions shall apply.
Activities of Daily Living: include, but are not limited to bathing, dressing, personal hygiene, transferring, eating ambulating, assistance with drugs that are normally self-administered, and changing bandages or other dressings.
It goes on to say:
...Care furnished on a visiting basis in Your home and by a care provider as defined by Medicare...
...Your attending physician must certify the type and frequency of the services that are necessary because of a condition for which a home care plan of treatment was approved by Medicare...
...Services must be received during the period You are receiving Medicare-approved home care services or no more than eight (8) weeks after the service date of the last Medicare approved home health care visit;
Benefits are not payable for home care visits paid for by Medicare or other government programs; nor for care provided by family members, unpaid volunteers or providers who are not care provider...
It still sounds like At Home Recovery is a benefit that is an extension of Home Health Care since it can be used after the last Medicare Home Health Care visit.
If in fact my clients who have received Home Health Care have told me ADL's were provided during regular Home Health Care visits. So, being able to continue help with ADL's after home health care terminates would probably be the most often requested reason for a claim for the benefits provided by At Home Recovery.
I stand by my comments. On many occasions I have witnessed Home Health Aid workers doing housekeeping chores while I was discussing Medicare plans with the beneficiary. I asked a few probing questions about their frequency and was told they come in daily.... and often when I drop by for a followup, the HHA worker is there again, usually doing the dishes, etc.
I formed an opinion that this was not going to last if CMS starts cracking down when taxpayer money runs out. That's why I said it can't be justified on a risk basis, because I don't think the present system will continue for long.
I am aware that Home Health Care must be ordered by the PCP. What gets me, is that oversight into what this devolves into is lacking. It won't be long before someone at CMS wakes up and issues a decree to restrict these abuses.
One example I witnessed was a beneficiary with diabetes. Someone with diabetes is not so invalid that they can't wash their own dishes. My sister has had diabetes since she was 5 years old, and takes very good care of herself and her modest home. Yes, she endures quite a bit of pain on a daily basis, but the exercise of working to care for herself is therapeutic. She does not have HHA come in to help... yet. She may have to if she goes on dialysis.
Another example was two seniors living together (both female) and one could have easily shared household chores with the other, but there was the HHA doing the dishes!
If the use of Home Health Care and At Home Recovery were kept to their designed benefits, not many HHA's would find work. Can you spell "vested interest"? Mark my words, CMS will bring an end to this abuse before long. (But first they have to crack down on all those agents foisting insurance plans on vulnerable seniors!!
)
- 15,319
Frankie, Frankie, Frankie.
How it that much different than what I posted?
What's SAI's opinion of that?
Rick
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