providers misleading clients re MAPD coverage

I’ve had multiple instances of Doc’s office people telling my clients UHC won’t pay for that - original Medicare will. The first instance was when an eye surgeon’s office told me that about blepheroplasty -eyelid lift. I showed them otherwise and they did it. I figured that was just an honest mistake but they just tried that again on a client. Another client was told by a different Doc that UHC MAPD wouldn’t cover an infusion and I know for a fact they pay fo my wife’s infusion.

By law, MAPDs pay for everything Medicare does. I don’t mind educating docs’ staff but I wonder how many times they get away with that.

Anybody else had similar experiences?
 
I’ve had multiple instances of Doc’s office people telling my clients UHC won’t pay for that - original Medicare will. The first instance was when an eye surgeon’s office told me that about blepheroplasty -eyelid lift. I showed them otherwise and they did it. I figured that was just an honest mistake but they just tried that again on a client. Another client was told by a different Doc that UHC MAPD wouldn’t cover an infusion and I know for a fact they pay fo my wife’s infusion.

By law, MAPDs pay for everything Medicare does. I don’t mind educating docs’ staff but I wonder how many times they get away with that.

Anybody else had similar experiences?

What are you smoking? I want some.

They "pretend" they are going to cover everything. Ask anyone in the medical field, they'll tell you the same thing.

Largest SNF company in TX? Post stroke. 88 min of therapy per day on MAPD. 144 on Original Medicare.

If you want to sell MAPD, that's totally fine.

But don't pretend that's it as comprehensive as Original Medicare. Its not even close.
 
I have found that there aŕe a lot of situations where the beneficiary would have been better off with original medicare with no supplement than a MA plan. If they can't afford a supplement then be careful enrolling in a MA.
 
I mean he is right that a mapd has to cover everything that original medicare does. The mapd fear on this board is strong
 
I mean he is right that a mapd has to cover everything that original medicare does. The mapd fear on this board is strong


Fear or ignorance ? Whenever I meet with a new to Medicare prospect and they tell me they have heard alot of bad things about mapd I know they have been talking to agents who don't offer a full portfolio of medicare health plans so they have to hate on mapd to get the med supp sale.To me this approach is trying to force square pegs in to round holes.I prefer the consultative sales approach.
 
I don't have to hate on anything to get a sale.

I also don't have to give Senior Citizens a false sense of security that its identical.

Hmmmm....do you want to be in a SNF begging for weekly approval to stay? AFTER you find one that takes your MAPD? And don't forget the check they want before they'll accept the transfer. Or do you want 100 days with no other requirements at any SNF you want?

I damn sure know which one my parents on.
 
Yes, MAPD plans cover what Medicare does, but that does not mean the authorization process is the same.

The example kgmom219 states happens a lot. I have friends who work in nursing homes who hate MAPD plans for that reason. They would rather have original Medicare all day long than fight with an insurance plan to get authorization for the same procedures.
 
But sometimes the MAPD plan doesn’t require the 3 day hospital stay... making it easier than original Medicare.

A big hairy rarely addressed issue is expected costs MAPD vs PDP. I can give you example after example after example of yearly Rx estimate on MAPD being $500-$1,500 lower than the stand alone PDP’s. Stand alone pdp can be a big racket.

If I was on 5 Rxs and you told me I could pay 120 for a supplement and $2,500 est for my yearly Rx costs (including premium)

OR

$0 monthly with a good network including some of the best hospitals in the country with estimated $1,275 in rx copays plus dental vision and hearing built in at no extra cost...

I think I’d take it. Immediate tangible savings of 2,665. Knowing my OOP max is there around 4K and statistics are in my favor that I likely won’t hit my max or even come close. If age 65 and 66 are good years I can pay a full year oop max and be OK.

(Spun a different way, should I spend $2,665 to eliminate $4k in calendar year risk? No way. Even an oop max of 5k I’m likely to say no).

Sure, I may have a bad year or two... but the savings add up and if I go from 65 to 90 without major issues I’m way ahead of the guy who bought the Supp and pdp who is now paying $250+ for his Supp monthly...

At the end of the day, over time, I bet 100 seniors on a good MAPD plan will likely keep more money in their pockets than 100 seniors on OM + Plan G + PDP + Dental/Vision.

The risk is real but it’s a manageable risk.

My wife’s 3 living grandparents - all in upper 80’s except her grandfather who just turned 90, all pay $0 monthly for an MAPD (Ohio/Arizona). The premium savings is huge at that age. None of them have experienced any 2nd tier care.
 
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But sometimes the MAPD plan doesn’t require the 3 day hospital stay... making it easier than original Medicare.

A big hairy rarely addressed issue is expected costs MAPD vs PDP. I can give you example after example after example of yearly Rx estimate on MAPD being $500-$1,500 lower than the stand alone PDP’s. Stand alone pdp can be a big racket.

If I was on 5 Rxs and you told me I could pay 120 for a supplement and $2,500 est for my yearly Rx costs (including premium)

OR

$0 monthly with a good network including some of the best hospitals in the country with estimated $1,275 in rx copays plus dental vision and hearing built in at no extra cost...

I think I’d take it. Immediate tangible savings of 2,665. Knowing my OOP max is there around 4K and statistics are in my favor that I likely won’t hit my max or even come close. If age 65 and 66 are good years I can pay a full year oop max and be OK.

(Spun a different way, should I spend $2,665 to eliminate $4k in calendar year risk? No way. Even an oop max of 5k I’m likely to say no).

Sure, I may have a bad year or two... but the savings add up and if I go from 65 to 90 without major issues I’m way ahead of the guy who bought the Supp and pdp who is now paying $250+ for his Supp monthly...

At the end of the day, over time, I bet 100 seniors on a good MAPD plan will likely keep more money in their pockets than 100 seniors on OM + Plan G + PDP + Dental/Vision.

The risk is real but it’s a manageable risk.

My wife’s 3 living grandparents - all in upper 80’s except her grandfather who just turned 90, all pay $0 monthly for an MAPD (Ohio/Arizona). The premium savings is huge at that age. None of them have experienced any 2nd tier care.
I don't think you can compare a check up on dental and vision and a couple of cleanings and maybe x-rays to dental/vision insurance.
 
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