The Once in a Lifetime Claim Payment

[WCMason]

I held my 14th and final educational seminar for the year last night.

At Q&A time one attendee says something along these lines to the group: "one thing everyone should know if they join a Medicare Advantage plan is that Medicare will pay one claim per lifetime if the Advantage plan won't pay it."

I politely tell her I don't think that's the case, never heard of that, and wouldn't know how that could really work. She was adamant that used to work for Medicare and that is how it worked. I obviously didn't want to challenge her, in very small part because you never know what screwy rule there might be that I've never heard of. I just told the group I'd never heard of that before, but if you only get one in a lifetime, save it for a big claim. Don't waste it on a $20 doctor visit.

Anyone heard that one before?

 

[Newby]

I held my 14th and final educational seminar for the year last night. At Q&A time one attendee says something along these lines to the group: "one thing everyone should know if they join a Medicare Advantage plan is that Medicare will pay one claim per lifetime if the Advantage plan won't pay it." I politely tell her I don't think that's the case, never heard of that, and wouldn't know how that could really work. She was adamant that used to work for Medicare and that is how it worked. I obviously didn't want to challenge her, in very small part because you never know what screwy rule there might be that I've never heard of. I just told the group I'd never heard of that before, but if you only get one in a lifetime, save it for a big claim. Don't waste it on a $20 doctor visit. Anyone heard that one before?

No. But if she used to work for Medicare care she would have to know more than the best agent ever would.

That's how that works isn't it? They upload tons of knowledge into their brain when they take that minimum wage job?

 

[axeman462]

There is a few situations that I think she could be getting confused with.

- Lifetime reserve days?
- Welcome to Medicare Visit
- Probably the big one: Hospice. When a patient goes into hospice Original Medicare takes over, and the Advantage Plans step aside

But heres the BIG question. If she worked for Medicare, and knows so much...What was she doing at your Medicare educational Seminar???

 

[Newby]

But heres the BIG question. If she worked for Medicare, and knows so much...What was she doing at your Medicare educational Seminar???

Maybe Dancing with the Stars was a rerun that night?

 

[somarco]

What was she doing at your Medicare educational Seminar???

She heard Wes was hot.

 

[yogooglethis]

I held my 14th and final educational seminar for the year last night.

At Q&A time one attendee says something along these lines to the group: "one thing everyone should know if they join a Medicare Advantage plan is that Medicare will pay one claim per lifetime if the Advantage plan won't pay it."

I politely tell her I don't think that's the case, never heard of that, and wouldn't know how that could really work. She was adamant that used to work for Medicare and that is how it worked. I obviously didn't want to challenge her, in very small part because you never know what screwy rule there might be that I've never heard of. I just told the group I'd never heard of that before, but if you only get one in a lifetime, save it for a big claim. Don't waste it on a $20 doctor visit.

Anyone heard that one before?

she must be referring to the ol PART C CoPay Mulligan....hahha. I will have to tell my female clients about this who are disappointed that their MA plan wont cover blepharoplasty surgery to lift their droopy eyelids

seriously though it doesn't sound right because MA covers what the original medicare covers.if payment for a valid medicare service is denied then beneficiary uses the appeal process that's in place for both original medicare and ma

 

[kstein]

While ma plans cover the same services, there are many situations where a ma plan can deny services for a specific reason, when original Medicare covers them. For example, the most common example would be denying a certain test and making a beneficiary go through an alternative path first. ( denying an MRI and requiring PT first)

 

[yogooglethis]

While ma plans cover the same services, there are many situations where a ma plan can deny services for a specific reason, when original Medicare covers them. For example, the most common example would be denying a certain test and making a beneficiary go through an alternative path first. ( denying an MRI and requiring PT first)

you mean MA plans manage care and original medicare just pays claims and ask questions later?

 

[WCMason]

While ma plans cover the same services, there are many situations where a ma plan can deny services for a specific reason, when original Medicare covers them. For example, the most common example would be denying a certain test and making a beneficiary go through an alternative path first. ( denying an MRI and requiring PT first)

I am not sure this is a fitting example. While true that an MA plan can deny a medical service that Medicare would have covered without an alternative path first, the beneficiary would not get that claim paid by Medicare if that happened. The beneficiary could appeal and if successful force the MA plan to pay the claim.

 

[kstein]

O ya I totally agree that if ma denies a service, you can't just decide to have original Medicare cover that claim mid year. This was more in response to the quote that said MA plans cover the exact same as Original Medicare.