UHC Dual Complete --GA

[yabadabadoo1026]

I get nowhere trying to get an answer from help desk-----------lots of confusion and looking for clarification before enrolling someone with sine out of network providers

On the Benefits at a Glance it shows $0 co-pay in both the in-network and out-of network columns BUT when you go into the SOB it clearly shows cost sharing differences between in and out

I have a suspicion but not nearly enough certainty to enroll a QMB and trust they wont get a bill for a non net-work provider.

Can anyone shed any light on the confusion within the enrollment book??????

 

[yogooglethis]

I get nowhere trying to get an answer from help desk-----------lots of confusion and looking for clarification before enrolling someone with sine out of network providers

On the Benefits at a Glance it shows $0 co-pay in both the in-network and out-of network columns BUT when you go into the SOB it clearly shows cost sharing differences between in and out

I have a suspicion but not nearly enough certainty to enroll a QMB and trust they wont get a bill for a non net-work provider.

Can anyone shed any light on the confusion within the enrollment book??????

the OON co insurance is what someone w/o medicaid would be responsible to pay.An OON provider who sees a member is accepting less for medicare covered services then what they would be getting for same services with full dual patient with original medicare.providers are not allowed to balance bill full dual members even though they do it all the time.

 

[yabadabadoo1026]

I get nowhere trying to get an answer from help desk-----------lots of confusion and looking for clarification before enrolling someone with sine out of network providers

On the Benefits at a Glance it shows $0 co-pay in both the in-network and out-of network columns BUT when you go into the SOB it clearly shows cost sharing differences between in and out

I have a suspicion but not nearly enough certainty to enroll a QMB and trust they wont get a bill for a non net-work provider.

Can anyone shed any light on the confusion within the enrollment book??????

the OON co insurance is what someone w/o medicaid would be responsible to pay.An OON provider who sees a member is accepting less for medicare covered services then what they would be getting for same services with full dual patient with original medicare.providers are not allowed to balance bill full dual members even though they do it all the time.

I would agree with your suspicion but me too with not enough certainty to risk a client getting billed

"someone without Medicaid" should not be in this dual plan---don't you have to be a QMB or full dual?

 

[yogooglethis]

I would agree with your suspicion but me too with not enough certainty to risk a client getting billed

"someone without Medicaid" should not be in this dual plan---don't you have to be a QMB or full dual?

plan is only suitable for qmb and higher medicaid level otherwise member is responsible to pay the co insurance amounts . for partial medicaid members this would be up to their monthly share of cost just like it would be for a non snp ma plan-in florida anyway.

 

[ILUVSAILZ]

There use to be a social service number with UHC (per helpdesk) for dual enrollment to verify their level so agent's are certain of co- insurance issue.

 

[agentjhc]

There still is a number to call--at least for UHC (idk about CI+) You have to be with the potential member and they will tell you yes or no on the spot. In my area the CI+ Dual Complete is lousy as is CI+ regular plan (Networks). The AARP Plan 1 is pretty solid just across the line in TN and the UHC Dual Complete Plan is pretty solid.

 

[yabadabadoo1026]

There still is a number to call--at least for UHC (idk about CI+) You have to be with the potential member and they will tell you yes or no on the spot. In my area the CI+ Dual Complete is lousy as is CI+ regular plan (Networks). The AARP Plan 1 is pretty solid just across the line in TN and the UHC Dual Complete Plan is pretty solid.

the CIP is worthless---they have cut the extra benefits down to such a laughable amount I cant even in good conscience push it

 

[agentjhc]

Yes, DC "extras" aren't there....network is horrible in regular plan. Especially hospitals, but docs limited as well.

 

[yabadabadoo1026]

Yes, DC "extras" aren't there....network is horrible in regular plan. Especially hospitals, but docs limited as well.

???????????? its "open network" here---PPO-----anyone that will accept it and bill them is good which is about everybody---

 

[agentjhc]

Ooops. Brain dead. you are right. I don't sell either product at this time.