PFFS Plans - STOP SELLING!

[senior-advisor-indiana]

Most new agents come here to see how they can make more money. THat is not a bad thing. We make money by HELPING seniors. I came here to see how I could make more money and make friends in the industry. I work to make money.

 

[James]

Bunch of Commission Whores, "Pale Skin HO's", now Imus could of said that and still be on the air .

 

[Frank Stastny]

You are right Frank....I actually meant to say the some who talk about making all the money. I apologize for that!

In the short time I have been here I have seen the salivating posts about making money a few too many times for my liking. Whether meaning to or not it shows bad form and gives our industry the bad reputation it has.

Last year I personally wrote 236.... With at least 150 of those being PFFS. The problem wasn't the plan, and we told people you could go anywhere that would accept the plan payment.

Anyone can right???? But if they would was another question. unfortunately in this county there were plenty of politics to keep the plan from being accepted.

We had doc offices here where the girls didn't even know what a PPO was..... They kept saying "we are not in their network!". There are some dumb people in this world that cannot grasp new ideas.

Now we just lost another HMO last week for this county that was a good plan.

Can I sell Med supps...Yes! The unfortunate part is too many people just can't afford them. very sad!

Thanks,

I totally agree with everything you said. I know an agent in SW Missouri, very rural, who owns an agency and she basically will not, nor let her agents, write PFFS plans in that area. The only exception is if someone is really at or near the poverty level and then she still cautions them about taking it. She said there are too many doctors in the area who will not accept them.

She also said that one doctor put up a sign in his office that if a patient has a PFFS plan that they should contact another doctor to see. He does not accept them.

I have experienced the same reply from people working in doctors office. When I asked the girls working in my doctors office about PFFS plans, they didn't have a clue what I was talking about! After about five minutes of talking to them I finally found out that they do accept Humana, but they didn't know what kind of plan that was.

I also talked to another agent who has been selling Med Supps for a number of years and now has thrown all his eggs in the PFFS basket. He said they are much easier to "sell". He tries to sell them to everyone! He is "in it for the money". He is now upset because his "plans to make thousands this year" have gone in the toilet.

I have a lot of seniors that are relatively healthy. Their primary care physician may accept the PFFS plans. However, what happens if they get really sick and the doctors they need to see don't accept them? Or, if they are out of town? I have a lot who travel a extensively also.

Can you imagine the frustration of being out of town, very sick, and calling every doctor in the Yellow Pages looking for one who accepts them? This will be further complicated by people working in the doctors office who won't have a clue what the person is asking about.

There is no doctor "network". At least with an HMO they know who they can and can't go see. This program the way it is now is nothing more than a crap shoot for those, especially in rural areas or who travel a lot, who sign up for them.

Just because "their doctor accepts it" doesn't insure that they will receive quality health care if they have to go see a specialist.

I don't like them and I'm afraid there are going to be a lot of seniors who are going to be in for a rude awaking if they travel a lot or get really sick.

 

[policy doctor]

Well here we go...

Just had a PFFS Coventry client call me. Appears some of his recent claims are not being paid by Cov and denied by Medicare. Weird, because some have been paid by Medicare. He just started in April '07.

I'm thinking that the paperwork pipeline is messed up between CMS and Coventry, or maybe the dr. billing clerk.

Told him to call the drs. office and get the insurance clerk...find out how they're billing his claims. They are taking his co-pays so he is not to be billed by them.

Too bad this guy was uninsurable when I wrote this (lung caner). But time will tell if I did him any favor, I'll let you know.

 

[policy doctor]

Oh yeah, forgot to add. He then went on to say he had a friend on Medicaid.....no Medicare. She was looking for a program to choose any doctor.....LOL.....man, I don't have anything. Talk about a lot of work .for nothing..... OOOPS...., shouldn't have said that. I'm crass.

 

[midwestbroker]

If you really want to sell MA plans, do it in a metro where HMO and PPO plans are available. That way you can show them the network with a provider book.

I agree with Frank that in the rural markets, you need an open network where you do not have to worry about plan acceptance.

If they want to really solve this problem, they need to in some way make all Medicare providers accept PFFS plans. I do not see that happening, but that is the only real way to solve this.

 

[senior-advisor-indiana]

If you really want to sell MA plans, do it in a metro where HMO and PPO plans are available. That way you can show them the network with a provider book.

I agree with Frank that in the rural markets, you need an open network where you do not have to worry about plan acceptance.

If they want to really solve this problem, they need to in some way make all Medicare providers accept PFFS plans. I do not see that happening, but that is the only real way to solve this.

If the PFFS plans pay the physicians the same as medicare( which they are suppose to) then all physicians should be forced to accept the plans. Why wouldn't they? Because the billing departments do not want to do extrra work to bill the PFFS company. Nobody like change. Med supps are the best. Here in IN we have a pland D that is only $70 a month. We have PFFS plans that are $0-$100.

 

[floridabroker]

The buzz owrd now in this county is when a doctors office wants to NOT take a plan they say they haven't been paid. This is the Universal health Care PFFS.

Then I speak to a hospital who is no longer accepting the PFFS. I ask is there any chance....NO!

She then proceeds to tell me it's not because the plan didn't pay. it is the leftover co-pays that the MEMBER isnt paying......HUH????

I said to her "So you are telling me you are hurting the company and decent folks who ae trying to save money with this plan because SOME people don't pay their bills?"

She said well yeah when you put it that way I guess you are right!

Holy crap....Theres an attitude.

In Brevard county these people have NO hospital that will accept them. Before lock out I tried to switch them to an HMO or supp or anything....They wouldn't do it because they got their Part B back.

Has anyone else seen fraudulent billing????

Again the buzz word has been this PFFS wasn't paying. Some of my former members have brought bills to me asking what they should do as the doctors office sent them bills.

At first I was pi$$ed because I thought this company just sucked and didn't pay their bills! To make a long story short checks were sent to the doctors for payment as i have now found out. The excuse from the doctors office to these members is OOPS!. This certain group of doctors who made sure of putting universal out of Brevard county has 4 of these incorrect bills that I have found so far. Coincidence???? Hardly!

Also had a doctor charge double what medicare allowable was until they got caught!

So my question is: Who is trying to do what is best for the senior???? The doctors and hospitals don't care...And CMS doesn't know what they know!

 

[policy doctor]

Well it's like i told my client with that MA. Once he paid that co=pay to the dr, THAT"S IT. He is not to get any bills of any kind. Stmts of payment is ok. So I told him not to pay any money....advantra pays what medicare would have paid to his provider. Drs. office real slow in reimbursing patient...this was true in the 80's with med supps before electronic billing. Patient paid his deductible, ins co paid it, then patient got another bill from dr and paid again. then after 2 mos dr. office said he had a credit on bill for his next office visit. LOL Nope let CMS and carrier duke this one out.

 

[Frank Stastny]

Well it's like i told my client with that MA. Once he paid that co=pay to the dr, THAT"S IT. He is not to get any bills of any kind. Stmts of payment is ok. So I told him not to pay any money....advantra pays what medicare would have paid to his provider. Drs. office real slow in reimbursing patient...this was true in the 80's with med supps before electronic billing. Patient paid his deductible, ins co paid it, then patient got another bill from dr and paid again. then after 2 mos dr. office said he had a credit on bill for his next office visit. LOL Nope let CMS and carrier duke this one out.

I agree about letting the carrier ans CMS duke it out. However, you have to remember, even though you are "only the messenger" everyone wants to "kill the messenger". I too have had that happen and the client always calls me and says, "you told me that I wouldn't have to pay". I am right but the doctor has other ideas and I can't make the doctor do anything.

My client still wants their money, not a "credit".