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I met a prospect yesterday who has Windsor Gold MAPD here in TN, he has had for the past 3 yr. He gets no extra help, with only about $1800 per mo. income. Late in 2008 he started Cancer treatments and they continued till early this year. The co insurance for chemotherapy is 20% or about $6k per year in 2009 and 2010. I talked to a supervisor at Windsor who told me the MOOP of $3400 would not take place until the member actually has paid the treatment center the full amount of $3400, and the member is on a payment plan with the center of $50/mo. That isn't the way I had understood MOOP to work. I thought when your co insurance amount reached the $3400 MOOP, the plan would "kick -in" to pay all other expenses.
( I don't contract with Windsor.) Its pretty early, so please forgive the poor statement of the problem my me.
That is the basics of the story. Does anyone have a comment or suggestion on how to advise this member or help me better understand how MOOP works on a MAPD?
( I don't contract with Windsor.) Its pretty early, so please forgive the poor statement of the problem my me.
That is the basics of the story. Does anyone have a comment or suggestion on how to advise this member or help me better understand how MOOP works on a MAPD?
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