Reasons for chargebacks?

[GreenSky]

So in your opinion,would you sign a dually on Evercare or Wellcare Concert plan,if those where the choices

You should only consider signing a full dual on a SNP plan specific for duals. WellCare does NOT have such a plan although they are pushing an inappropriate plan strongly.

Those with a share of cost might benefit from an MA plan.

Rick

 

[thebrit]

Thanks for your reply Rick,my state manager actually told me to enroll this client in a Wellcare Duet plan,.So if you where enrolling duallys who would you use.Thanks

 

[GreenSky]

Thanks for your reply Rick,my state manager actually told me to enroll this client in a Wellcare Duet plan,.So if you where enrolling duallys who would you use.Thanks

This depends on the state. In California, Health Net has a true SNP plan for duals and it's very good.

The problem with the duet plan is the same as with any PFFS. Their doctor does not have to accept the plan. So you take someone off Medicaid where they have no problem seeing their current providers and put them on a plan that may not be accepted. There is no incentive (like higher reimbursement) for a provider to want the Duet plan.

I don't specialize at all in duals. I wrote maybe 3 this year. From what I understand, they drop faster than Britney's breasts. There are so many other products you can sell - specifically Med Supps - that working with duals is not too attractive.

Now, if you are talking about chronic illness SNP plans, that's a different story. In some counties, Evercare has a SNP PPO (not here in Calif) and that is a very attractive option.

Rick

 

[GreenSky]

Thanks for your reply Rick,my state manager actually told me to enroll this client in a Wellcare Duet plan.

Just wondering. What state and if you have a manager, does that make you captive?

Rick

 

[thebrit]

I live in Utah,not captive,am appointed with Wellcare,United Health,Molina.Why do you ask?.Thanks again

 

[OneMorePolicy]

.....if the person is Medi-Medi, they can (and probably will) cancel very quickly. In fact, it is likely not appropriate to sign a dual eligible into a SH plan - especially the PFFS.


If you are located in the Los Angeles area, I'll be happy to meet with you and give you a quick run-down on Medicare and Part C. It's not terribly complicated but if you don't know what you're doing, not only will you screw up yourself, but you could put you client in a position where he or she cannot receive medical care.

Rick



How I wish I were in your area, but I'm in NorCal (Silicon Valley). Much appreciated though as I'm inclined you could help a great deal on this steep learning curve. Any alternatives\recommendations for getting a "quick run-down on Medicare and Part C" that's not an in-person meeting?

If the person is medi-medi, what typically is done, if anything?

Many thanks again.

 

[fostever]

Chargebacks should not be a problem because unless the person is dual eligible, they can only change plans bascially once a year (there are a few exceptions).

Send me a PM if you'd like information on contracting with them.

Rick

Is that the MA rules in California? Illlinois states you can change twice during AEP/OEP. If you have LIS or the state wrap around prescription coverage it's all year just like duals. I though Medicare rules were nation wide.

 

[GreenSky]

Is that the MA rules in California? Illlinois states you can change twice during AEP/OEP. If you have LIS or the state wrap around prescription coverage it's all year just like duals. I though Medicare rules were nation wide.

It's a federal law.

I said they could change "basically once in an year." Most people only will move in the AEP. I don't think there will be much movement in the OEP so chargebacks won't be a big issue.

If you're working duals, you are setting yourself up for chargebacks. LIS people are a little different but they tend to stay put.

Rick

 

[fostever]

It's a federal law.

I said they could change "basically once in an year." Most people only will move in the AEP. I don't think there will be much movement in the OEP so chargebacks won't be a big issue.

If you're working duals, you are setting yourself up for chargebacks. LIS people are a little different but they tend to stay put.

Rick

Yeah I know. I shy away from dualies,but have about 25 who have been on the books for a couple years. We help them apply for dual eligibility when they join our MAPD and then move them into our Total Care plan. It covers everything at zero co-pay and extra benefits like transportation, cash in an account to pick medically related items from a members only magazine, and other extras. Our state is 100 days behind to pay out for medicaid claims so alot of private practices are not taking medicaid people. Lately I've been following a former agent who used to be with my regular MA plan. He goes in and switches them to his new crappy plan with $195/day-20days co-pay for inpatient hospital (no annual max.) I show them $175/day for 3 days($1500 annual max) and it's a done deal. He tells them the plan just changed names and to sign here for the new years benefits. During AEP the last agent to sign them gets the client. These people are really grateful and are good referral sources since they know others in the hood who had seen this jerk. He used to be with Humana and spent 2 years switching his book of business to our plan. Now he is with Secure Horizons and moving them again. Real creative, huh.

 

[mcday]

What are the steps to help someone apply for dual eligibility?

Mike