Question: Hospitals vs Carriers available SEP to move client with MAPD

[InsuranceGuy29]

Sounds like a shitty hospital who doesn't really care about their patients. I know insurance carriers take the blame for this, but it's really the hospitals. They could easily extend it, at least until the end of the year.

Hospitals are the gatekeepers of accepting plans or not accepting plans. If I was a patient of theirs, I wouldn't want to continue going there after that.

If they're gonna throw me under the bus and use me as contractual leverage and cannon fodder, as a patient, what else are they gonna do in terms of the care I'm receiving.

This is exactly how I personally feel, and this is exactly what I would be telling my clients. There's plenty of other great hospitals out there. No thanks.

 

[Moosedrool]

A hospital group here in K.C. is in contract dispute with a carrier and will leave the carriers plan on 08/01/24. Letters went out from the carrier to the members so they are notified that they won't be in network as of that date if they don't settle.

I don't see any SEP's to use for this situation. Some agents are saying to use the "Disaster SEP" like the calling centers use all the time but I know that doesn't really fit the circumstance.

When I enroll clients in MAPD's I warn them of this but the $0 offer is irresistible to some of them and the others will never get sick or are too poor.

Any secret SEP's out there?

Loss of SPAP... I'm assuming the beneficiary is on a HMO? And I'm assuming all their Doctors in the plan you're looking at are in Network?

 

[TwoCents]

Loss of SPAP... I'm assuming the beneficiary is on a HMO? And I'm assuming all their Doctors in the plan you're looking at are in Network?

Just to be clear -- you're suggesting using loss of SPAP even though it's likely not true, right?

 

[Millwood]

Sounds like a shitty hospital who doesn't really care about their patients. I know insurance carriers take the blame for this, but it's really the hospitals. They could easily extend it, at least until the end of the year.

Hospitals are the gatekeepers of accepting plans or not accepting plans. If I was a patient of theirs, I wouldn't want to continue going there after that.

If they're gonna throw me under the bus and use me as contractual leverage and cannon fodder, as a patient, what else are they gonna do in terms of the care I'm receiving.

This is exactly how I personally feel, and this is exactly what I would be telling my clients. There's plenty of other great hospitals out there. No thanks.

So how do feel about these same Insurance company's when they make MA , MAPD, & PD plans non-commissionable? When they don't pay on Med Supp GI, Med Supp disability, Birthday/Rule etc. Would you tell them to find a different agent because they won't write it for nothing? That the agent isn't in it for them.
Funny how we look at things when it doesn't affect our pocket book. Basically 5 companies control 90% of all healthcare squeezing agents and providers for every last dime. It's not a fair fight . It's like bringing a pea shooter to a machine gun fight.

 

[InsuranceGuy29]

So how do feel about these same Insurance company's when they make MA , MAPD, & PD plans non-commissionable? When they don't pay on Med Supp GI, Med Supp disability, Birthday/Rule etc. Would you tell them to find a different agent because they won't write it for nothing? That the agent isn't in it for them.
Funny how we look at things when it doesn't affect our pocket book. Basically 5 companies control 90% of all healthcare squeezing agents and providers for every last dime. It's not a fair fight . It's like bringing a pea shooter to a machine gun fight.

Completely separate issue as to the main point I’m talking about. Any hospital that drops patients in the middle of the year is a shitty hospital. End of story.

 

[Millwood]

Completely separate issue as to the main point I’m talking about. Any hospital that drops patients in the middle of the year is a shitty hospital. End of story.

So I see it completely different. The contracts should be January 1st to December 31st. If the Insurance company locks in the client for a year the Insurance company's contract should be for the same period. Same thing with drug formularies.

Most of the negotiations are initiated on the insurance side. If the insurance companies couldn't negotiate during the middle of the year they would have much less leverage. If it were Jan 1st to December 31st most clients could make better choices and tell the insurance companies to go pound dirt. They could make an informed choice for a full year. Not this Russian Roulette let's hope the insurance company doesn't make changes mid year.

You totally ignored my point about working for less or nothing. So I'll ask the question are you going to work for nothing or at a loss if it's what's best for the client? NOT talking about just a few select, but all clients. You insinuated hospitals and providers should...... will you?

 

[InsuranceGuy29]

So I see it completely different. The contracts should be January 1st to December 31st. If the Insurance company locks in the client for a year the Insurance company's contract should be for the same period. Same thing with drug formularies.

Most of the negotiations are initiated on the insurance side. If the insurance companies couldn't negotiate during the middle of the year they would have much less leverage. If it were Jan 1st to December 31st most clients could make better choices and tell the insurance companies to go pound dirt. They could make an informed choice for a full year. Not this Russian Roulette let's hope the insurance company doesn't make changes mid year.

You totally ignored my point about working for less or nothing. So I'll ask the question are you going to work for nothing or at a loss if it's what's best for the client? NOT talking about just a few select, but all clients. You insinuated hospitals and providers should...... will you?

I honestly don’t even follow what you’re saying to me and you’re all over the place, injecting points that don’t even pertain to what I’m talking about.

That’s why I’m not addressing it. It’s not relevant at all to what I’m speaking about.

Main post said they are having a contractual dispute with a hospital group and as a result, the hospital group chose to drop the insurance carrier. That’s a choice the HOSPITAL made.

Doctors and hospitals are free to drop insurance carriers at any time. This wasn’t a decision made by insurance.

The hospital group could have at least waited until the end of the year, so that the patients still in the plan could at least find another carrier.

That’s the only point I’m making. Whatever else you’re talking about has zero relevance here.

 

[Medicare bro]

what hospital group and what carrier? I’ve been out of the country and haven’t read all emails or have missed one.
Also, your thoughts on the exit of BS MAPD and what MS carrier option would pay more than a minimum if using GI in this instance?

The Hospital group is HCA, which is the largest in the country. The provider is Aetna who got their butts handed to them.

 

[StevenjKSU]

Also, your thoughts on the exit of BS MAPD and what MS carrier option would pay more than a minimum if using GI in this instance?

Carriers that are paying more than $25 on GI MO Anniversary business (That I am aware of):

Unitedhealthcare
Cigna
Wellabe
Ace

 

[mkblinzler]

Carriers that are paying more than $25 on GI MO Anniversary business (That I am aware of):

Unitedhealthcare
Cigna
Wellabe
Ace

Thank you for replying. I spoke to CIGNA this week and 14.5% for MO policy anniversary rule because it is a state law. However going from MAPD who exits to MS the GI commission is only 2% because it is a federal law.
I know Wellabe is $25
I have to confirm UHC