Doctors taking Medicare but not Medigap?

[sunny1ib]

Gosh vic120,

I know, they were bugaboos with me too. I just figure out a workaround. Usually I ask if they can share the part in their contract that states the exclusivity of their specific plan and where it state NO ORIGINAL MEDICARE. It used to work for me, as most people who had issues with it originally knew what it was going in and made decisions to either give up the supp or join the MAPD. If they were clients of mine who moved from Sarasota to The Villages, they would just find another provider as they preferred to work with me. New people, I would explain how it worked.

I hardly received calls prior to my move north in 2019. I believe I heard that new homeowners received information about The Village medical offices and there were plans that were exclusive to Village residents or something along that line...it has been a while.

 

[vic120]

Gosh vic120,

I know, they were bugaboos with me too. I just figure out a workaround. Usually I ask if they can share the part in their contract that states the exclusivity of their specific plan and where it state NO ORIGINAL MEDICARE. It used to work for me, as most people who had issues with it originally knew what it was going in and made decisions to either give up the supp or join the MAPD. If they were clients of mine who moved from Sarasota to The Villages, they would just find another provider as they preferred to work with me. New people, I would explain how it worked.

I hardly received calls prior to my move north in 2019. I believe I heard that new homeowners received information about The Village medical offices and there were plans that were exclusive to Village residents or something along that line...it has been a while.

Yea I seen the letter also, ANd it was specific and mentioned Medigap plans will NOT be accepted

The thing is these residents were already using the docs few years and was close and convenient

We ended up switching to The UHC MAPD plan to keep the clients

 

[somarco]

Its not that none take Medicare, but most of the good ones there don’t. They only take uhc MAPD.

Seems a bit disingenuous . . .

So only "bad" doctors accept original Medicare? How do you define bad?

 

[somarco]

even if they did say they won't take Medicare Part B (the Mayo Clinic in Jacksonville used to NOT participate (THEY DO NOW))

Not entirely correct . . .

At one time Mayo did not accept ASSIGNMENT . . . allowing them to balance bill xs charges. JAX Mayo was one of several clinics that used this ploy.

I understand they have since agreed to take Medicare assignment.

They always took Medicare B as far as I know.

If they want to exclude taking any specific insurance plan, it is their prerogative as it's a private practice.

It is my understanding that a provider who has admitting privileges at a hospital that accepts govt funds of any kind must also accept Medicare patients.

 

[Travis Price]

And as sshafran stated, providers can do whatever they want to do. If they want to exclude taking any specific insurance plan, it is their prerogative as it's a private practice.

In theory, yes.. this is accurate. However, Medigap plans are kind of an exception. Namely because if they accept Original Medicare, there's no reason for them to reject the Medigap plan. Medicare makes all claim decisions and the gap plan just pays their portion.

It's why Bob doesn't really *need* to show his card. The insurance company doesn't make any decisions on payouts on claims. Secondly, technically you shouldn't make any payments until you receive your benefits statement, especially in HDG/F situations.

If my doctor opted to really argue me on it, I'd just find a different doctor.

 

[Chazm]

Seems a bit disingenuous . . .

So only "bad" doctors accept original Medicare? How do you define bad?

By poor reviews. The main clinics in the villages only take uhc MAPD, and not OM. They have better online reviews, or so I’ve noticed. Most people that you talk to in the villages only want those doctors.

 

[somarco]

The insurance company doesn't make any decisions on payouts on claims. Secondly, technically you shouldn't make any payments until you receive your benefits statement

True

Medicare, not the insurance carrier, adjudicates and approves claims. The dog wags the tail, not the other way around. Medigap carriers are not allowed to conduct a second adjudication process.

In a claim dispute (from your client) start with the MSN to see what was approved & repriced and what was denied. Then compare the Medigap EOB to see what they did and did not pay and why some things were not paid.

I have never paid before reviewing the MSN.

 

[Consulting]

If I had a Supplemental company called "The Acme Insurance Company" Plan G. Then the doctor will gladly take a check from "The Acme Insurance Company". As long as the doctor accepts Medicare Assignment, then you are good to go with any GAP insurance company. The GAP plan will pay whatever they are supposed to pay according to the Medicare Adjudication.

 

[goillini52]

If I had a Supplemental company called "The Acme Insurance Company" Plan G. Then the doctor will gladly take a check from "The Acme Insurance Company". As long as the doctor accepts Medicare Assignment, then you are good to go with any GAP insurance company. The GAP plan will pay whatever they are supposed to pay according to the Medicare Adjudication.

How many states is Acme in and how are their rates?

 

[vic120]

How many states is Acme in and how are their rates?

I don't know but this guy still cant use his OTC correctly