Selling PFFS

Tobal

New Member
8
I've been having trouble with myself on selling PFFS plans. Somehow I am not convinced that a lot of providers accept the terms of payment my carrier provides in my area. It seems like everytime I call a provider up and ask if they take the Fee for Service plan, they would seem all confused about what I am talking about.

The PFFS plan sounds very good when it does not constrain my clients to any network of doctors but the concern is that I wouldn't know where to lead them to for doctors if they do not have any. Each time I try to contact a physician's office they just don't know what I am talking about and just keep asking me if this is a PPO or HMO.

I feel like I am selling my clients with a PFFS with no additional premium and extra benefits, however I cannot gauge what doctors are out there that accepts these plans.
 
Don't talk to the person who answers the phone in the office. Always ask to be transferred to billing or something. They'll know. Once you find a doc that you know is taking new patients and accepts your plan get some feed back from your client that you sent and see how they liked their experience.
 
Grab a brochure and go to the billing department and ask.

Some PFFS plans are slow payers. Nothing stops the PFFS plan faster then a slow payer. Of course there can be other reasons...
 
well whats funny is that I ask the billing department and sometimes they just don't know and the Medicare PFFS plan name is not listed. How widely accepted are PFFS plans?
 
From my experience it doesnt matter who you talk to at a Doctors office they will never know what you mean by PFFS. Then when you say the company (I.E. Coventry, Wellcare, Todays Options) They will just give you a flat out NO.

Doctors dont know how this works, until they have billed it before.

This year we sold a lot of Coventrys Freedom 5 plan and it was new to our area. So far not one doctor has denied a client. I can however see PFFS's being an issue if they are slow to pay, they will most likely not accept the insurance at this time.

I cant imagine a doctor turning a patient away they have served for 5, 10, 15 years because of a PFFS, I can however see it if the PFFS does not pay.
 
I have had a few clients call there doctors billing dept. about a Todays Options PFFS so far evey doctor says they take it and have had no problems....knock on wood...
 
I've sold about 100 PFFS plans in Indiana and Kentucky and never a problem.

I think more of a problem comes if the plans are sold to people who aren't able to pay the co-pays or don't understand the co-pays.
 
You have to know your area. I've got over 700 PFFS plans on the books and I know the area of western Ky and southern In and how they are accepted. There is only one Doctor that I know won't take them and I tell my clients that.

I also used to do some SNP's in Tn. There is no way I would go into the Nashville, Tn. or Clarksville, Tn. area and try to sell PFFS plans because I don't know the level of acceptance.

If there is ever a sliver of doubt, I call the client's Dr. from the home and make sure it will be accepted. That helps the client feel better too.

I hate the unknowns of the PFFS plans as much as anyone, but, they are the order of the day in my area. We don't have PPO/HMO plans except for the one Humana PPO. It's a terrible plan, but, I wouldn't sell Humana even if it was a good plan.

If you don't know the lay of the land on acceptance with any PFFS plan you sell, don't sell it until you do know. They are too difficult even when you know. For examply, I just had a new enrollee terminate her plan. I spoke to her this morning and she said she was just afraid that it wouldn't be accepted from reading the literature. I asked her if she had found a Dr. that wouldn't take it, she said, "no, every Dr. or clinic I've called said they will take it. I just read in there that they could change and that worries me." I told her that I understood because life is too short to sit around and worry about your MA plan.

I am no longer marketing these plans just because of the unknown. The only ones I do now are from referrals or people I run into during other lines of work and ask me about their Medicare options. When that happens, I pull out the SOA form and get it signed. I don't get back to them for, at least, a week. I'm really hoping they will lose interest in that week. If they haven't, I go meet with them and explain the plans.
 
They can accept PFFS today and not tomorrow, they can accept you on a pffs and not your neighbor. Acceptance is at the doctors discretion.

I could never put my mother on a plan that has this kind of inconsistencies!
 
They can accept PFFS today and not tomorrow, they can accept you on a pffs and not your neighbor. Acceptance is at the doctors discretion.

I could never put my mother on a plan that has this kind of inconsistencies!


Yes, that's true on paper. In the real world, it doesn't happen. Doctors either accept them or they don't. The only Dr. in this area that doesn't take them is a doctor that doesn't take any insurance of any kind.

But, I do see, as funding gets cut, that there will be doctors that start not taking them. The PFFS will be a goner in a couple of years anyway.
 
Back
Top