Medicare approved amount vs. Medicare paid amount, what's the diff?

[JONATHAN B SPARKS]

Thanks Travis!

 

[somarco]

The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.

https://www.cancer.org/content/dam/...igures/2019/cancer-facts-and-figures-2019.pdf

Cancer Statistics

Mayo Clinic Releases Paper on Cancer Drug Pricing Economic Trade-offs

 

[Travis Price]

You'll find you generally don't have to convince Medicare people they need some sort of plan to lower their exposure. It's convincing them to trust YOU that you're giving them the best value.

Need isn't the problem. Not feeling like they're getting ripped off or tricked is the struggle. People target tf out if seniors. So the majority of the sales process is putting them at ease.

 

[somarco]

I don't doubt Belk is in left field regarding insurance. I was trying to form a real world example with historical claims to counter any prospects who share his opinions.

Very few folks will have seen this video. Only 138k views in 3 years. My guess is most of those views are insurance agents.

Numbers don't convince folks to buy your plan vs another. Most folks will become even more confused if you try and paint the reason for (or against) a supplement (or MA) and end up doing nothing.

Or at least nothing with you.

"That last guy I talked to sounded like he knew what he was doing but I had no idea what he was talking about. He seemed more interested in trying to SELL us something vs answering our questions. Sure glad you came along".

 

[somarco]

I don't doubt Belk is in left field regarding insurance. I was trying to form a real world example with historical claims to counter any prospects who share his opinions.

Very few folks will have seen this video. Only 138k views in 3 years. My guess is most of those views are insurance agents.

Numbers don't convince folks to buy your plan vs another. Most folks will become even more confused if you try and paint the reason for (or against) a supplement (or MA) and end up doing nothing.

Or at least nothing with you.

"That last guy I talked to sounded like he knew what he was doing but I had no idea what he was talking about. He seemed more interested in trying to SELL us something vs answering our questions. Sure glad you came along".

When a beneficiary is in the hospital and a variety of doctors see her, are all the doctors’ fees under Part B subject to the 20% coinsurance? Which, if any, doctor’s services in the hospital are billed under Part A? For example, is emergency treatment is Part B for the attending doctor’s billing purposes?

Charges incurred in the hospital as an INPATIENT and BILLED by the hospital are Part A. Every other claim incurred in the hospital but BILLED by outside sources is Part B.

Absent a Medigap plan, the beneficiary pays Part B charges (above the deductible). They continue to pay until they get well, run out of money or die.

 

[somarco]

If a veteran is happy with The VA, why should he or she pay for Part B? I understand it doesn’t hurt to have broader resources of healthcare but, if The VA is serving them well, is it worth it?

The site seems to be sluggish and buggy. Having trouble posting . . .

Unless you live in an area served by the VA and have one or more military bases in the area, I doubt you will run into that many folks that have and want to rely solely on the VA for care.

I have a few clients with service related disabilities and will use the VA from time to time. They want the ability to get care anywhere and any time without relying 100% on the VA.

Most have bought a G plan, a few HDF.

I don't decide for them. They are the one who usually bring it up.

Some agents sell them a MA plan.

 

[JONATHAN B SPARKS]

Thank you! I’m sorry if I’m being thick-headed about this but, how do I know which doctor’s services in the hospital are Part B and subject to 20% coinsurance? Would the hospital always bill the doctor’s work in scheduled heat bypass surgery as Part A as long as it’s inpatient? Is there no time when a doctor’s services would be billed as Part B as long as the patient has been admitted as inpatient? I just want to make sure I understand this correctly.

You’re very kind to help me! I wish I could offer something in return. Here’s something you may find useful. I heard it many years ago from Mike McConnell, 700 WLW, Cincinnati, The Big One. We’re not supposed to offer any such advice to clients but, you may personally find it useful. It works every time for me:

Got acid reflux but there’s no meds around? Flap your arms against the sides of your ribcage kind of like you’re doing the chicken dance. McConnell says do it 50 times but it only takes about 20 for me. It looks silly but I’ve never had anyone report that it doesn’t work. It ends the acid reflux every time. (A doctor told me that, while this technique may alleviate the symptoms, you still want to treat it with meds due to potential damage you may not feel.)

 

[somarco]

, how do I know which doctor’s services in the hospital are Part B and subject to 20% coinsurance?

When you get the bills, you will know.

Would the hospital always bill the doctor’s work in scheduled heat bypass surgery as Part A as long as it’s inpatient?

No.

Hospital will bill for surgery, recovery, room, supplies, etc.

Surgeon and anesthesia billed separately as Part B unless these providers are on staff.

Is there no time when a doctor’s services would be billed as Part B as long as the patient has been admitted as inpatient?

MOST of the time any doc charges are Part B even though the pt is inpatient. Exception is a staff doc.

We’re not supposed to offer any such advice to clients but, you may personally find it useful. It works every time for me:

You do what you want but I NEVER speculate on claims. NEVER. Not ever.

But if giving advice on claims works every time for you, go for it.

BTW, if your client comes back on you because the claim was not paid as you suggested your E&O won't cover it.

 

[junkman]

I love how agents selling MA say "you can always go back to regular Medicare if you don't like the Advantage." They seem to forget about underwriting.

On the other side, people say "I've never had a problem " (but have never been sick).

Sometimes I want to choke both.

Those who have money mostly buy supplements. Those who have more money buy into concierge services to be at the top of the care list

.Those who don't have money talk about how smart they are to get their gym membership for free.

Let them do whatever they want as long as they do it with you.

 

[JONATHAN B SPARKS]

When you get the bills, you will know.

You do what you want but I NEVER speculate on claims. NEVER. Not ever.

But if giving advice on claims works every time for you, go for it.

BTW, if your client comes back on you because the claim was not paid as you suggested your E&O won't cover it.

I was saying that we're not supposed to offer medical advice to clients so don't share the acid reflux fix at your seminars. Thanks, Somarco! I'm very grateful for your help!