Providers Extracting Extra Money from SecureHorizons Members

[floridabroker]

I'm just going to through this out there.

Does your concern stem from fear of losing the contest?

Any relation to Ken Westphal?
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Good call on both points!

WOW!

I don't know who Ken is and, I rest my case!
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Great to see you lead by example.

Sorry for telling it like it is!

 

[Josh]

WOW!

I don't know who Ken is and, I rest my case!
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Sorry for telling it like it is!

You're not telling it like it is and you don't get the purpose of this forum. Check under the general agent discussion section and look for the thread "what is the purpose of this forum?"

 

[floridabroker]

You're not telling it like it is and you don't get the purpose of this forum. Check under the general agent discussion section and look for the thread "what is the purpose of this forum?"

The purpose of the forum is to get personal with people and infer they are less than other people?

As others have mentioned in this thread that is what THEY also are getting from this forum. People bash what other people sell, what they believe, what they do.

I personally come here for ideas and to see what other successful people are doing.

What I see too often is vulgar and unprofessional.

Look do what you want, I am just saying that you are advertising a service in your tag. Your post turns me off and you may want to consider that it does the same to others.

 

[Josh]

Look do what you want, I am just saying that you are advertising a service in your tag. Your post turns me off and you may want to consider that it does the same to others.

You're under the impression I'm actively seeking clients and will pander to get them. The fact of the matter is that allhealthandlife doesn't understand his Medicare products and got the answer to his question. Unfortunately he took it personal and got defensive which I found amusing, but the lesson taught was valid nonetheless. If you're that easily confused, I'd rather not have you as a client.
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The purpose of the forum is to get personal with people and infer they are less than other people?

Sound a bit melodramatic, don't you think?

 

[floridabroker]

You're under the impression I'm actively seeking clients and will pander to get them. The fact of the matter is that allhealthandlife doesn't understand his Medicare products and got the answer to his question. Unfortunately he took it personal and got defensive which I found amusing, but the lesson taught was valid nonetheless. If you're that easily confused, I'd rather not have you as a client.
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Sound a bit melodramatic, don't you think?

Your right!

Don't pander to get clients.

Not dramatic medplansolutions, I just won't do business with people who lack class.

You just strike me that way. No offense!!

And just so we are clear, I wasn't even pointing my comments directly at you. You are not the only one in here who lacks manners or class.

 

[allhealthandlife]

One thing I instruct my clients - not just Medicare (which includes Med Supps and Medicare Advantage), but Major Medical - is that they have a RIGHT as consumers to ask the doctor's office what will be performed, and how it will be billed.

I am taken up on this more times than not, and inevitably gets calls thanking me. If people know up front what is done and how much it will cost them, there is less frustration when the bill comes.

Just my two cents worth.

Thank you for responding on topic.That was my point - that the billing office at some doctors are getting creative and a simple litmus test to see whether or not the charges are valid is if they have been submitted to the carrier in the first place.I understand that reimbursement rates are low for providers accepting original medicare and MA but it's not fair and possibly illegal that they try to extract extra charges out of patients that are ignorant of their rights.
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How do you do it? I have a tough time keeping up with my book of business and it's nowhere near 4,000 strong. You've got to be pulling in $750k plus annually with that amount on the books.

I wish they were all still active and about half of the MA where when I was employee with a MA carrier and I don't get to keep those.I had very good years in the hey day of MA ( 2005-2008) but never even half of 750k

 

[Josh]

And just so we are clear, I wasn't even pointing my comments directly at you. You are not the only one in here who lacks manners or class.

In many ways this forum is more like a bunch of grumpy old (and occasionally smart) men sitting around a bar. This isn't a board room meeting or a training seminar, it's a bunch of insurance agents talking about insurance along with some politics and other nonsense.
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Thank you for responding on topic.That was my point - that the billing office at some doctors are getting creative and a simple litmus test to see whether or not the charges are valid is if they have been submitted to the carrier in the first place.I understand that reimbursement rates are low for providers accepting original medicare and MA but it's not fair and possibly illegal that they try to extract extra charges out of patients that are ignorant of their rights.

One of the other major challenges most medical offices face is the turnover rate in their office. A provider may very well wish to be billing correctly, but with things changing so frequently they sometimes simply make mistakes. To make matters worse, when you call the carrier, if you talk to 5 different customer service reps you can easily get 5 different answers.

 

[floridabroker]

Thank you for responding on topic.That was my point - that the billing office at some doctors are getting creative and a simple litmus test to see whether or not the charges are valid is if they have been submitted to the carrier in the first place.I understand that reimbursement rates are low for providers accepting original medicare and MA but it's not fair and possibly illegal that they try to extract extra charges out of patients that are ignorant of their rights.
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I wish they were all still active and about half of the MA where when I was employee with a MA carrier and I don't get to keep those.I had very good years in the hey day of MA ( 2005-2008) but never even half of 750k

ALLHEALTH:

I am having a similar situation with overcharges no one can figure out.

I also have been having EverCare members telling me their PCP's are pushing them to move to other PCP's (basically wanting to get rid of them) with goofy excuses like "you should get a PCP closer to you".

The best part is "sarcasm" the first people the clients blame is the insurance compay.... THANK YOU MR. PRESIDENT!!!!

 

[Russ]

....a simple removal of skin cancer in a doctors office is usually covered under the OV charge.Do you think original Medicare would allow a total of $ 1400.00 for a visit to a dermatologist for a skin lesion removal.

It is true that a removal of skin cancer in a doctors office is usually covered under the OV charge. I keep all of my mom's Medicare EOMB's. She's had quite a few skin cancers removed in the doctors office and it's broken down as part of the office visit.

Medicare usually allows(approves), between $150-$200 per lesion.

 

[allhealthandlife]

ALLHEALTH:

I am having a similar situation with overcharges no one can figure out.

I also have been having EverCare members telling me their PCP's are pushing them to move to other PCP's (basically wanting to get rid of them) with goofy excuses like "you should get a PCP closer to you".

The best part is "sarcasm" the first people the clients blame is the insurance compay.... THANK YOU MR. PRESIDENT!!!!

I believe it may have something to do with the fact that these are PPO plans and these specialist visit do not need to be pre authorized therefore charges are not predetermined before the visit.This same person who was charged 1400.00 for this OV with a skin cancer removal on SH PPO has gone back to Humana hmo and now is only being charged the 40.00 OV co pay from the same doctor for the same service like he was before he switched to SH 1/1/10