I have a client that is pretty set on using me for her agent. She has a Med Ad plan now that is being terminated. She also has cancer and I cannot find a plan on sunfire that covers him. His office provided the client with a list of carriers but not plans. How would a PPO work for her? Would she just have to pay out of pocket for the dr and be reimbursed by the carrier? (This is my first season as an agent and this has been my only real curveball.)
NJ patient
- Thread starter jrb434
- Start date
So it's a network problem? You need to see which MAPs pay out of network and which ones doe not (obviously avoid those that do not). You also need to look at the max out of pocket for out of network (that varies a lot) and aim for something on the lower end if possible.
As far as having to submit her own bills to insurance that entirely depends on the medical facility with respect to what they will make her do (or for that matter pay up front her copay). She needs to call the medical facility she wants to use and find out exactly what the deal is.
If she can't afford the out of network out of pocket tell her to see what the rules are where she plans to get treated with respect to unpaid bills. Some places send you to collection, sue and cut off care. Others do some of that and others do none of that. If possible she needs to be seen at a place that won't cut off care and sue if she falls behind on the bills.
When you say 'him', are you possibly referring to a doctor? It took me 3 reads before that seemed to be likely what you were asking.
If that is the case, then do not trust anything you see on Sunfire as far as in or out of network. Take the list of carriers and go straight to their provider directories and look up ALL of her doctors.
Is there no upline helping you learn these things?
If that is the case, then do not trust anything you see on Sunfire as far as in or out of network. Take the list of carriers and go straight to their provider directories and look up ALL of her doctors.
Is there no upline helping you learn these things?
This is one of the wackier responses I've ever seen here. Call the doctor's office before treatment and inquire about their no-pay policy?
No you call the billing office and ask what their billing policy is, payment plans, what happens if you fall behind, etc. It may be one of the stranger replies you have seen but sometimes if people are screwed financially because of their insurance networks and can't afford the MOOP then they have no choice if they want to continue to have care. Not even remotely the best choice in an ideal world but if that is their only fall back plan (eg not paying the bills because they can't afford them and can't afford to make the payment plan in full every month that place would set them up with) then it makes sense to make sure they won't have care cut off because they can't pay.
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