I Can't Believe what I Am Reading

[kgmom219]

It never occurred to me that an opt-out provider could/would take MA plans. What happens when you appeal an issue and the MA carrier still refuses your request? If the provider has opted-out of Medicare I would assume CMS has no authority to override the MA carrier.

There's a doctors group in North Tarrant County (Ft Worth) with 6 offices. They have NOT opted-out. However, the patients are informed at age 64, via mail, that they only accept 2 MA plans. It does NOT say that they do not take Medicare/Supplements.

So when I called to get the scoop and finally got the administrator, I got the same answer I had been given 5 other times, by 5 other people.

"We only accept MA 1 and MA 2".

If I asked another question, I got the same answer. If I asked if the docs had done opt-out, I got the same answer. It was very obvious they knew they were in the grey and didn't want to give any other answer. It was a script they were reading, probably approved by their lawyer.

I finally asked her if I could meet for a drink and buy her 1 or 2 margaritas to get a real answer. She hung up on me.

 

[wehotex]

There's a doctors group in North Tarrant County (Ft Worth) with 6 offices. They have NOT opted-out. However, the patients are informed at age 64, via mail, that they only accept 2 MA plans. It does NOT say that they do not take Medicare/Supplements. So when I called to get the scoop and finally got the administrator, I got the same answer I had been given 5 other times, by 5 other people. "We only accept MA 1 and MA 2". If I asked another question, I got the same answer. If I asked if the docs had done opt-out, I got the same answer. It was very obvious they knew they were in the grey and didn't want to give any other answer. It was a script they were reading, probably approved by their lawyer. I finally asked her if I could meet for a drink and buy her 1 or 2 margaritas to get a real answer. She hung up on me.

Lol. Which MAs were they?

 

[somarco]

CMS is the supreme ruler of all MA's

 

[kgmom219]

Lol. Which MAs were they?

Care and Care PPO. Aetna MAPD.

 

[WCMason]

It never occurred to me that an opt-out provider could/would take MA plans. What happens when you appeal an issue and the MA carrier still refuses your request? If the provider has opted-out of Medicare I would assume CMS has no authority to override the MA carrier.

I used the term "opt-out" for Kelsey-Seybold but all I know is that they don't take original Medicare and tell their existing patients that they cannot continue to see them when they go on Medicare unless they take either their own or one other Advantage plan. It may not be a formal opt out and if that's the case they would likely still be subject to all of the CMS rules.

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Care and Care PPO. Aetna MAPD.

That sounds like Family Healthcare Associates in Tarrant County. I haven't run across them as much recently as I don't do as much in the Dallas market anymore but last year they accepted these two MA plans you mentioned plus United Healthcare and Humana MA plans. But no Original Medicare, so no med sup. They would give their T65 patients a letter explaining that and directing them to call what I think was a local agent. They are another example of a provider group that takes MA but not med sup.

 

[steveadlman]

When they drop their Med Supp to take out the MA Plan they will get a GI to go back to Original Medicare and get back their Supplement for 12 months. What is bad for these folks is that after the 12 month period has expired they have to go through medical underwriting to apply for a Med Supp. If they have any serious health conditions they could be denied coverage. What happens then if they don't like the MA Plan?

 

[yogooglethis]

When they drop their Med Supp to take out the MA Plan they will get a GI to go back to Original Medicare and get back their Supplement for 12 months. What is bad for these folks is that after the 12 month period has expired they have to go through medical underwriting to apply for a Med Supp. If they have any serious health conditions they could be denied coverage. What happens then if they don't like the MA Plan?

In Fl. AARP and BCBS med supps have very limited underwriting

no hospitalization in last 90 days
no esrd
no pending surgeries

Your approved!

 

[MedicareAgent]

I spoke with Claudia Hadley up there, some manager of uhc team and she said, "the didn't opt out of Medicare but since the rules have changed with Medicare, they can choose whether to take it or not so they have chosen to not take Medicare red white card or supp, only uhc mapd)
Clear as mud now right?

 

[TN_agent]

Perhaps they are not taking NEW (meaning, additional) original Medicare patients. And anyone aging in would fit that bill, unless on the MA they want them on.

 

[yogooglethis]

The aren't accepting Medicare but only a private insurance plan from UHC. Obviously the capitation makes them more money.

Simple as that.

Rick

Capitation with outcomes that improve star rating is even mo money.I believe this is a tipping point for the MA penetration trend.

Should be a banner year for MA agents in the Villages as early indications are UHC will have as good or better benefits in 2017