Schwetna PPO and Dental Reimbursement...

Jan 21, 2016

  1. Mrs.A.Mann
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    Quick rant - why is a plan that costs $68 a month so difficult to use? Yet, still has a 4.5 star rating???

    First year for the client on Aetna.. because it's a PPO and the 1k dental reimbursement, but there's not a bit of information on how the plan pays, how it works, how she goes about reimbursement. Called customer service and they don't know polka-dotted sheets either...

    What gives?

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    quick note to GreenSky... thank you in advance for your kind words and for taking time to share your wealth of knowledge, in that awesomely supportive way that you do...
    Thanks Buddy!
     
  2. TDFnCali
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    Try Security Life for dental & vision plans.
     
    TDFnCali, Jan 21, 2016
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  3. FLM2
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    Did you ever think about reading the Evidence of Coverage for the plan? It will tell you how those benefits work-without a network dentist it's worthless, too bad you didn't realize that before enrolling the person.
     
    FLM2, Jan 21, 2016
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  4. sman
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    No offense, but you really should understand a product and how it works before selling it to someone. If you don't know the answer, how do you expect the client to know the answer?

    Is this a stand alone dental plan or packaged with a Medicare Advantage plan?
     
    sman, Jan 21, 2016
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  5. GreenSky
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    And now you know what the problem is.

    Rick
     
    GreenSky, Jan 21, 2016
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  6. FLM2
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    It's part of the Aetna MAPD PPO plan in at least some states-it looks like a great benefit until you realize that almost no dentists (at least in the areas I have the plan) will accept it and then it's basically worthless.
     
    FLM2, Jan 21, 2016
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  7. Mrs.A.Mann
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    As much as I love a good ribbing... I had also spoken with an experienced broker who specialized in Aetna before selling the plan... it seemed straight forward, but what I have come to find, repeatedly is that it's better to come here and get the ribbing than it is to proceed. Again, thanks for the love!

    Side note: I worked for Aetna in their call center 2014 and see clearly now that we were scripted and mislead folks. I'm thrilled to no longer be that person, and want to extend my gratitude for giving me a break while learning the ropes (in your own special way ;0)
     
  8. WCMason
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    The member can go to any licensed dentist and then submit the claim to them for reimbursement.

    Sometimes the annual benefit is split into preventive and comprehensive maximums but that is spelled out in the enrollment book in the plans I have seen
     
    WCMason, Jan 21, 2016
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  9. Mrs.A.Mann
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    It's a reimbursement built-in-dental Aetna Value Plan (1K), and the thing is that the plan has 4.5 stars. They can't afford complaints as they're definitely going for 5. It seems like there would be better on-boarding to explain this process. I haven't seen what comes to clients but I understand this information isn't included.

    There's no problem with reimbursement... it's the process. It's that there isn't a guide to using their dental benefits - only select dental services are reimbursable... What are they? If couldn't possibly be a worthless plan because, again, folks would complain to the hilt. Folks are paying $68 a month for it who could otherwise pay $18.

    Again, I'm going back to the fact that they earned a 4.5 star rating... and they're not about to jeopardize their rating over something this trivial (which is starting be be not so trivial anymore).

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    That's what I've come across also...

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    But there is no network, so no doctor will accept it. It's reimbursable.
    So then we go to, that the doctor has a standard form to fill out and provide with the receipt, but how does she know ahead of time what codes are reimbursable?
     
  10. sman
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    And your above statement helps your current and potential clients how? You can certainly come here, ask a question and then get a little miffed at the responses. But ultimately it's up to you to know what you're selling and how it works. That includes the dental benefit of a Medicare Advantage plan.

    For example, if it's a PPO, you might want to get a copy of the directory prior to offering the plan. There's a good chance that a potential client would want to know if their dentist is in network. Additionally, you definitely want to know the specifics of the benefits (i.e. - patient responsibility for services provided). Does the plan offer any benefit if the person uses an out of network dentist? And even knowing how a claim is filed is helpful. These are things clients want to know. If they can't get those answers from the person recommending the plan, then who are they going to get them from? And if your response is just tell them to call the company, then you've added no value to your client other than helping them get enrolled in a plan which they could have done by going directly to the company.

    The Aetna MAPD PPO plan here in Georgia has a VERY small dental benefit included with the plan. It is a reimbursement plan. The beneficiary gets a copy of the bill and submits it to Aetna and gets reimbursed up to the plan limit. Pretty straight forward. But I made sure I understood that before recommending the plan to anyone because I knew those types of questions would come up.

    You can get mad about the advice given here, but it's better to accept some constructive criticism and work towards being the best you can so you are a resource to your clients. Just my two cents.
     
    sman, Jan 21, 2016
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