Time to get my feet wet

[senior-advisor-indiana]

I use the same method Frank, now we are screwed. The doctors iin my town didnt except assignment up until last year. The way you can tell if they do is look at their last EOB (explanation of benefits) and there will be a note underneath with a code and it should say " your provider accepted medicare assignment. Another way to find out is normally if a doctor doesnt accept assignment they will require the patient to pay up front and then get re imbursed by medicare and thier supplement.

 

[Frank Stastny]

There is one other reason some agents only sell Plan F. It is because they really don't know Medicare very well and are too lazy to do the research to find out.

They figure Plan F is "safe" to sell and that way they can't get themselves in trouble. For those agents, if they researched the changes in Medicare that took place in the 90' they too would be able to do a better job of serving their clients.

The day the changes went into effect, doctors by the tens of thousands across the US began accepting assignment who had never accepted assignment before. That is the day I started selling Plan D.

Many agents even tell prospects that they have 100 days of nursing home care with their supplement. That also is a bold face lie. Medicare will not pay one penny if someone has to go to a nursing home because they can't take care of themselves.

You can also "blow their current agent out of the water" if their agent has told that. Some LTC agents will also tell them that so they can sell them a LTC policy with a 100 day elimination period.

When the person has to go to a nursning home, it isn't until then that they find out that they have to pay for the first 100 days out of their pocket.

If you know Medicare extremely well, you are well on the way to selling a lot more of your prospects.

I try to be totally differnt than any agent they have ever talked to before. I'm relaxed, laid back and don't try to sell them anyting. I just explain logically why I know Plan D is the best.

It really is the one my mother and other relatives have and I tell them so. Then I say, "do you really think I would recommend something to my mother that wasn't the best"?

I just love this business.

 

[Cenla Agent]

I usually get some resistance at first. I consider that to be a good thing because it leads me easily into why Plan D is better.

Regarding the Part B deductible. I show them the premium for Plan F and the one for Plan D. With Continental Plan D for a 65 yr old female is $93.25, a Plan F is $140.17. A difference of $46.92 per month. (Premiums will be different in other states and other companies, but in most cases Plan F will be much higher.)

I then tell them that they are paying an extra $46.92 per month ($563.04 per year.) just to get the insurance company to write the Dr. a check for the Part B deductible, $131, when they can do it themselves and save $432.04 per year.

If they bring up excess charges, I tell them about the change in Medicare in the mid 1990's and since then virtually all doctors now accept assignment. (If you are not familiar with the changes let me know, they totally changed the kind of Plan people need.)

Then, if necessary, I ask them to call their doctor and verify that the doctor accepts assignment. Hence, no excess charges. (It is a bunch of B.S. that their surgeon probably does not accept assignment. That's what agents tell people who know that their doctor accepts assignment, trying to scare them into thinking that they may still have to pay thousands of dollars out of their pocket.)

I point out that Plan D has At Home Recovery, a potential $1,400 benefit each year and that Plan F does not have that benefit.

It they keep insisting that their current agent told them they would be putting themselves at great financial risk by not having Plan F I then explain to them that all agents work on straight commission and the more expensive the policy is the more money they make. If necessary I even tell them what my commission is on a Plan D and what it would be on a Plan F.

I then ask them if they now realize why their agent was so insistent about telling them they have to have Plan F.

When I finish with all that they are usually looking for a pen wanting to know where to sign.

Do you think that they will ever talk to their former agent after that, let alone consider keeping their F and cancelling the D that they just took with me? Hell no they won't.

I just love it when a prospect tells me they have a Plan F. That is money in the bank for me.

I encourage all agents in Missouri to ONLY SELL PLAN F.

That is what their marketing organizations and companies are telling them. I'm just reinforcing it.

In my admittedly limited experience, I'd say it's far more likely to find a Primary Care Physician that doesn't accept assignment (some don't generally any accept ins. at all and require upfront payment) than find a surgeon or specialist who doesn't. I have heard of a few, but they are rare.

Regarding commissions, at least one company (UCT) subtracts the Part B deductible from the gross premium when calculating commissions on plans that pay it, so there is not as much of a financial incentive to sell F with that particular company.

Many companies, including United World, do not sell Plan D, at least not in my state. Plan G is similar to D (at home recovery, doesn't pay the Part B deductible) except that the supp will pay up to 80% of any Part B excess charges with G.

 

[Guest]

I think I posted this before but for the exact same reasons Frank outlined so nicely, only 2% of my clients have plan F...for now.

 

[Frank Stastny]

In my admittedly limited experience, I'd say it's far more likely to find a Primary Care Physician that doesn't accept assignment (some don't generally any accept ins. at all and require upfront payment) than find a surgeon or specialist who doesn't. I have heard of a few, but they are rare.

Regarding commissions, at least one company (UCT) subtracts the Part B deductible from the gross premium when calculating commissions on plans that pay it, so there is not as much of a financial incentive to sell F with that particular company.

Many companies, including United World, do not sell Plan D, at least not in my state. Plan G is similar to D (at home recovery, doesn't pay the Part B deductible) except that the supp will pay up to 80% of any Part B excess charges with G.

None of the Med Supp companies pay commission on the total premium of a Plan F or on Plan C. They all, that I know of, deduct usually more than what the Part B deductible is.

With a Med Supp policy there is no such thing as a "primary care physician". That is usually only a term used by HMO's. With a Supp policy all doctors are paid the same and there is no need to "get permission" to see another doctor if the person wants a second opinion.

If the doctor does not accept assignment the doctor can not add more than 15% to what Medicare Approves. If an individual goes to the doctor and the doctor orders a bunch of tests all of the tests are paid 100% by Medicare. The doctor is really only adding 15% to the office visit for which Medicare usually only approves around $40.00. However, if the doctor does not accept assignment Medicare reduces the amount they approve by 5%. If you do that math I think it figures out that the doctor is only getting around and extra 9.5% and not the full 15%. (You math wizes can probably come up with an exact amount.)

Also, if the doctor does not accept assignment Medicare sends the check to the individual and so does the insurance company. Now the doctor has to collect from the patient. If the doctor does accept assignment the checks go directly to the doctor.

You said, "some don't generally any accept ins. at all and require upfront payment". It doesn't mean that they don't accept insurance, they will still file with Medicare and Medicare and the ins. co. will still send the check to the doctor. Now the doctor has collected twice and owes the patient the money collected. I have run across doctors that keep all of it. We nailed one doctor for doing that in St. Charles, MO. He had been doing it for years. He paid dearly and lost his license for a while.

I tell my clients if their doctor insists on doing that have the doctor call me and I can assure him/her the money will be paid. Either that or get a new doctor. Several have gotten new doctors.

I don't know of any surgeons in MO that do not accept assignment and only know of two doctors that do not accept assignment. Plan D is still a better value even for patients of those doctors. The extra they have to pay per office visit is usually around $4.00.

I heard today that World is coming out with a Plan D. I was told fairly soon.

 

[Frank Stastny]

I use the same method Frank, now we are screwed. The doctors iin my town didnt except assignment up until last year. The way you can tell if they do is look at their last EOB (explanation of benefits) and there will be a note underneath with a code and it should say " your provider accepted medicare assignment. Another way to find out is normally if a doctor doesnt accept assignment they will require the patient to pay up front and then get re imbursed by medicare and thier supplement.

I don't understand when you say "now we are screwed". How?

There are doctors that accept assignment who also "require" the patient to pay up-front. Do they then refund the payment to the patient?

I am really surprised that doctors in your town just started accepting assignment. In MO the day the changes went into effect almost every doctor in the state began accepting assignment.

It just isn't logical for them not to accept assignment. They get their money from Medicare and the insurance company and don't have to worry or pay some to do the billing. That is just plain not good business, especially for an extra 9+%.

Have you tried calling a bunch of doctor's offices and asking?

Have you suggested to your clients who's doctor does not accept assignment, that they ask the doctor if he/she will for them? A lot of doctors if they don't accept assignment for "everyone" will make an exception for an individual patient.

 

[Cenla Agent]

None of the Med Supp companies pay commission on the total premium of a Plan F or on Plan C. They all, that I know of, deduct usually more than what the Part B deductible is.

With a Med Supp policy there is no such thing as a "primary care physician". That is usually only a term used by HMO's. With a Supp policy all doctors are paid the same and there is no need to "get permission" to see another doctor if the person wants a second opinion.

If the doctor does not accept assignment the doctor can not add more than 15% to what Medicare Approves. If an individual goes to the doctor and the doctor orders a bunch of tests all of the tests are paid 100% by Medicare. The doctor is really only adding 15% to the office visit for which Medicare usually only approves around $40.00. However, if the doctor does not accept assignment Medicare reduces the amount they approve by 5%. If you do that math I think it figures out that the doctor is only getting around and extra 9.5% and not the full 15%. (You math wizes can probably come up with an exact amount.)

Also, if the doctor does not accept assignment Medicare sends the check to the individual and so does the insurance company. Now the doctor has to collect from the patient. If the doctor does accept assignment the checks go directly to the doctor.

You said, "some don't generally any accept ins. at all and require upfront payment". It doesn't mean that they don't accept insurance, they will still file with Medicare and Medicare and the ins. co. will still send the check to the doctor. Now the doctor has collected twice and owes the patient the money collected. I have run across doctors that keep all of it. We nailed one doctor for doing that in St. Charles, MO. He had been doing it for years. He paid dearly and lost his license for a while.

I tell my clients if their doctor insists on doing that have the doctor call me and I can assure him/her the money will be paid. Either that or get a new doctor. Several have gotten new doctors.

I don't know of any surgeons in MO that do not accept assignment and only know of two doctors that do not accept assignment. Plan D is still a better value even for patients of those doctors. The extra they have to pay per office visit is usually around $4.00.

I heard today that World is coming out with a Plan D. I was told fairly soon.

I know there's no distinction b/w PCP and specialist under Original Medicare but you kept saying surgeon, so I pointed out that surgeons will generally accept assignment. Almost all of the doctors I know of who don't are PCP's. Some of the PCP's who don't accept assignment (some of whom work on a cash only basis) actually charge less than the allowed amount like $50 or so for an office visit.

 

[Cenla Agent]

I don't understand when you say "now we are screwed". How?

There are doctors that accept assignment who also "require" the patient to pay up-front. Do they then refund the payment to the patient?

I am really surprised that doctors in your town just started accepting assignment. In MO the day the changes went into effect almost every doctor in the state began accepting assignment.

It just isn't logical for them not to accept assignment. They get their money from Medicare and the insurance company and don't have to worry or pay some to do the billing. That is just plain not good business, especially for an extra 9+%.

Have you tried calling a bunch of doctor's offices and asking?

Have you suggested to your clients who's doctor does not accept assignment, that they ask the doctor if he/she will for them? A lot of doctors if they don't accept assignment for "everyone" will make an exception for an individual patient.

Making exceptions for individual patients goes for PFFS as well.

 

[Frank Stastny]

The only reason I said surgeons is because some agents, when they find out that the prospect's doctor accepts assignment, tell them that many surgeons don't, trying to scare them into taking an F so they can make more money.

That is the only reason I mentioned surgeons. For no other reason.

In Missouri, I would venture to say, judging by what my clients have experienced, and the doctors offices I have personally called, 99.999% of all doctors do, and have since the change in Medicare rules, accept assignment regardless of what kind of doctor it is.

I'm really surprised that you know so many doctors who do not accept assignment.

Believe me, I'm not trying to argue with you. You may very well be right in everything you say.

 

[senior-advisor-indiana]

Hey Frank, I was saying "we're screwed" because you let the secret out of not selling plan F. It was a joke. I'm not sure if i was confusing you but what I was saying is...... I have never ran into a dr. besides my small hometown,that didnt accept assignment.

They do now. But when they didn't accept assignment they made the patient pay up front, they do not do that anymore.

Most people's chiropractor makes them pay up front also. I assume they do not accept assignment also.