- 7,066
Hopefully in the toilet where the PFFS plans belong. (HMO & PPO I can tolerate, sorta kinda.) Probably not for 2009 but we can still hope for 2010 and beyond.
Once again, I'm "holding back".
Medi C & D Insurers Plummet
- Thread starter MedSuppPro
- Start date
Hopefully in the toilet where the PFFS plans belong. (HMO & PPO I can tolerate, sorta kinda.) Probably not for 2009 but we can still hope for 2010 and beyond.
Once again, I'm "holding back".
- 598
This is great I think i made a prediction about these plans several months ago. How much red tape do we need to deal with, agents, doctors, seniors???
The part C rules are ridiculous the training with each company has been a joke. They could have offered one Federal training class to cover any and all companies you represent.
I still think that companies should have the right to design Med Supp coverage to cover benefits of their choice, they would still have to be approved by each state, so if a company got over creative and designed the plan too confusing for seniors to understand the state could deny it.
Competition makes products better, where is the competition with these lettered Med Supps......? Release them let companies design plans, let seniors choose...
I just read thru the national association of home builders that congress wants to standardize home designs you will have 12 choices take it or leave it! Great Idea!!!!!
i'm back
The part C rules are ridiculous the training with each company has been a joke. They could have offered one Federal training class to cover any and all companies you represent.
I still think that companies should have the right to design Med Supp coverage to cover benefits of their choice, they would still have to be approved by each state, so if a company got over creative and designed the plan too confusing for seniors to understand the state could deny it.
Competition makes products better, where is the competition with these lettered Med Supps......? Release them let companies design plans, let seniors choose...
I just read thru the national association of home builders that congress wants to standardize home designs you will have 12 choices take it or leave it! Great Idea!!!!!
i'm back
floridabroker
Expert
- 74
It's too bad Congress can't figure out where all the money goes.
The medicare fraud we see on a yearly basis from our members is frightening. Funny thing is many of these issues come from Doctors that will ONLY accept supps and Medicare.
Call me old fashioned but I am in this to help people. I have people all the time now that are dropping a doctor to go on an HMO plan because of the low co-pays and no premium. The Doctors (egomaniacs) have said to people "too bad" when they have asked the doctors to join the plan. I have had doctors offices tell people to go on supps. I'm sorry are they going to pay for them! That's ballsy in my opinion!
100% is 100%. So why won't they take it??
Before someone cites UHC I know they pay less than 100% but frankly the plan sucks and the service sucks more. No wonder they just laid off 4K.
Congress needs to work with the doctors and needs to understand their are people who don't make the money they do.
I don't care if the MA's premiums go to $50. That is still $100 less than the supps.
We have kept track since May 1st. 20 people per month average are calling us who have supps that are now calling about the zero premium plans asking if they can switch.
The rising price of gas and food have finally tipped the scales.
Sad!!
The medicare fraud we see on a yearly basis from our members is frightening. Funny thing is many of these issues come from Doctors that will ONLY accept supps and Medicare.
Call me old fashioned but I am in this to help people. I have people all the time now that are dropping a doctor to go on an HMO plan because of the low co-pays and no premium. The Doctors (egomaniacs) have said to people "too bad" when they have asked the doctors to join the plan. I have had doctors offices tell people to go on supps. I'm sorry are they going to pay for them! That's ballsy in my opinion!
100% is 100%. So why won't they take it??
Before someone cites UHC I know they pay less than 100% but frankly the plan sucks and the service sucks more. No wonder they just laid off 4K.
Congress needs to work with the doctors and needs to understand their are people who don't make the money they do.
I don't care if the MA's premiums go to $50. That is still $100 less than the supps.
We have kept track since May 1st. 20 people per month average are calling us who have supps that are now calling about the zero premium plans asking if they can switch.
The rising price of gas and food have finally tipped the scales.
Sad!!
- 19,619
I'm not even remotely suggesting that Wellcare offers a PFFS SNP. Nor has it been marketed that it is, at least, not here. I don't know where you have seen it marketed that way. It says plainly on the cover of the Wellcare book you give to people, "Private Fee for Service Plans". If you don't read the cover, it's on every page in the book. When I get on the phone call for the telephonic enrollment, they tell the member that it's a PFFS plan. When they do the verification call, they again tell them it's a PFFS.
Granted, I've only been doing the Wellcare this year, so, if you are speaing of something in the past, I have no knowledge of it.
As far as it not having anything for the doctor, I'm not selling it to help doctors. It's amember benefit. The doctor is going to get the same maoney from the plan as he would from original medicare. He would get more opportunites to charge, though. Since the PFFS plans do not have the 2 year limit on mamograms, colonostomies, etc. Of course, the PFFS plans do have wellness coverage, which, if the member takes advantage, may lead to less illness by the member thus less need to see a doctor.
I didn't realize some agents had a problem with PFFS plans out of concern for the doctors. That's got to be an original idea.
- 598
I'm not sure why you would sell a dual eligible plan, that is here in Georgia. Medicare and Medicaid really can't be beat, I would hate to mess with that!
Is it something that really benefits the member or is it beneficial to the pocketbook?
Is it something that really benefits the member or is it beneficial to the pocketbook?
- 7,066
I don't disagree with anything you have said. I also said over a year ago that I felt the PFFS plans were doomed.
Regarding letting insurance companies design their own Med Supp Plans. It use to be this way up until 1991 I believe. The different plans were approved by the states and agents sold the hell out of them.
The problem was that there were no laws regulating what the plans covered and how many different plans a person could have. They found seniors with 3, 4 and even 5 different Med Supp plans.
An agent would meet with a senior, look over their current plan and find "holes" in plan. Tell the senior that it was a good policy but had gaps. That, if they added the agents plan to the one they already have that they would be "100%" covered. (Even today I know agents who will sell a senior on Medicare with a Med Supp policy a hospital indemnity plan and/or a cancer policy.)
The conduct of both companies and agents is what forced the fed to come up with the "standardized plans" and the rules and regs regarding the coverage they providd.
Although it obviously didn't work back then maybe it might work now but I doubt it. There is way too much greed out there on the part of companies and some agents. Companies are designing the PFFS plans and we have already seen what a disaster those are becoming. (You can ague that point if you wish but I sure wouldn't sell my mother one.)
I believe it would be sad day if Med Supps went away and insurance companies were at liberty to develop their own policies to sell to seniors.
- 15,319
The way it was presented to me was that it was designed for dual eligibles. While no one ever used the term "SNP", it was implied that it was a plan for Medi-Medi. The reality is that it never was and from what I understand (correct me if I'm wrong) that is why CMS stopped the sale of Duet.
I was told by the regional sales rep that WellCare paid 100% of the Medicare allowable. Turns out they pay 80% just like Medicare. When I found this out, I decided there was no advantage to California residents to go into the plan.
As far as concern for the doctor, if the doctor does not want to accept the plan, that is a concern. This has been the issue with PFFS all along, not just WellCare's plans.
In California, Medi-Medi people have terrific benefits including vision and dental. I know this is not the case in all states. I know that the dual SNP plans are a good value in Ohio but they are HMO plans.
In California, there is little reason for a full dual to be on any kind of managed care plan. The negative of not knowing if your doctor will take the plan makes putting a dual on a PFFS a little "iffy."
Rick
- 15,319
- 7,066
You may think that is "ballsey" but where is it written that a doctor has to do anything or should be forced to or dictated to about who they should treat and what insurance they should accept.
How about if I tell you that you have to represent x company even though you neither like that company or would choose to represent them. Does that make you an "egomaniac"? Do you really need a reason and have to justify to someone else what you do and how you run your business? I don't and I would raise hell if someone told me I had to.
I would say the same thing you are accusing doctors of saying, "kiss my ass", it is my business and I will run it as I see fit. Who are either you or me to tell a doctor, dentist, insurance agent etc how to run their business?
What about the doctors who won't even see Medicare patients? What do you think of them? Should they be forced to see seniors on Medicare? I think not.
You have said you are
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