Selling PFFS

[Newby]

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.

JD, is that Dr. Buckmaster that you're running into?

 

[jdeasy]

JD, is that Dr. Buckmaster that you're running into?

That's him. I go to him. He won't take my insurance either. I have to pay him and then send in my receipt to Anthem for reimbursement.

 

[Frank Stastny]

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!

That is the main problem that I have with PFFS plans and primary reason I will not sell them. Some agents have told me that really isn't a major concern in large metro areas where doctors have been accustom to dealing with HMO's for the past several years. They may very well be right.

I no longer prospect in St. Louis and KC. I now only work in rural Missouri and from my experience, it is a major consideration and potential problem for those living in the "sticks".

Last year a woman who lives in the country called me and wanted a PFFS plan. After explaining it to her she decided to opt for a Med Supp instead. A couple of months later she called and said she had gone to the doctor that morning and she saw a sign in his office saying he would NO LONGER accept any Medicare Advantage Plans.

She said the sign was not there the week before. I just can't justify putting my clients in that kind of plan regardless of how much commission they pay.

My mother still has a Med Supp. Not all "old people" are poor, regardless of what they say or what agents may think. Some still want the flexibility and freedom that a Med Supp provides.

 

[policy doctor]

This is one of those discussions without end because it's based on the area you're marketing in and the provider acceptance. In large metro areas a PFFS is a non-issue for most clients; perhaps because there is much competition and large networks that most providers have to deal with.

Lately i've been reading and hearing about doctors not wanting to take medicare patients, or limiting the ratio of medicare patients to their non-medicare ones. (I believe we discussed this about 10 months ago) And now my awareness is being raised to "private contract" physician care. You pay your doctor a "fee" of $1500/year which includes preferential visits and care as needed. Those are doctors unwilling to participate in medicare.

Medicare Assignment for Original Fee-for-Service Medicare | California Health Advocates

Another interesting article was in AHIP how med advantage reimburses drs more than insurance plans. HMMM


Older Americans Have Coverage, but Too Often Can't Find a Doctor Who'll See Them

 

[Newby]

That's him. I go to him. He won't take my insurance either. I have to pay him and then send in my receipt to Anthem for reimbursement.

I've heard from people that he won't accept ANY insurance but I never knew for sure.