MAPD out of network radiologist question

[LostDollar]

Weird there are only 4 ways it can happen yet it happens with 100% of my MA clients. 20 years with no E&O claim. How can that be? Sometimes I think you are stuck back I the 80’s with all your managed care advice you give.

Same goes with the ER, they go to ER with chest pains and they do EKG, stress test etc they come out with 110.00 copay every time.

Didn’t say they disappear. If 12000.00 is approved then client pays 110.00 and MA plan pays 11890.00. Not sure why it’s so hard to understand what a copay means.

You are deliberately being obtuse.

When one goes to the emergency room there are bills from multiple Part B providers for one visit. Your posts are describing MAPD co-pays from only one Part B provider for the visit and implying that the Part B bill from the hospital chain providing the emergency room facility is the only bill a person will receive for their ER visit.

 

[Midlevel]

You are deliberately being obtuse.

When one goes to the emergency room there are bills from multiple Part B providers for one visit. Your posts are describing MAPD co-pays from only one Part B provider for the visit and implying that the Part B bill from the hospital chain providing the emergency room facility is the only bill a person will receive for their ER visit.[/QUOTE

OK, you win. You obviously have dealt with MAPD copays alot more then I have the last 15 years. I haven’t looked at anyone’s EOB or anything. Why are you even here trying to spew your BS when you clearly have no idea what you are talking about. Get a fricken hobby.

 

[DonP]

You are deliberately being obtuse.

When one goes to the emergency room there are bills from multiple Part B providers for one visit. Your posts are describing MAPD co-pays from only one Part B provider for the visit and implying that the Part B bill from the hospital chain providing the emergency room facility is the only bill a person will receive for their ER visit.

The mapd company pays the different drs just like your Medicare sup does . The clients responsible for the $90 bill for the emergency visit period .

 

[Midlevel]

The mapd company pays the different drs just like your Medicare sup does . The clients responsible for the $90 bill for the emergency visit period .

You may have 1000 on the books but LD and Somarco know way more then you and I about how MA plans work.

 

[somarco]

I once worked with an agent that had 30 years experience in the health insurance market but asked me to help him find coverage for the son of a business insurance client. He said he could not figure out why no one would write him since he looked healthy.

Pressing, I asked about any conditions diagnosed and/or treated.

He said the boy has CF but that was all. The agent had no idea that CF was a progressive, fatal disease (at that time).

This agent was a regional manager with several agents under him, yet he had no idea why a carrier would not issue a policy.

This was many years ago yet it is apparent that today there are agents who have no idea how insurance works.

 

[Midlevel]

I once worked with an agent that had 30 years experience in the health insurance market but asked me to help him find coverage for the son of a business insurance client. He said he could not figure out why no one would write him since he looked healthy.

Pressing, I asked about any conditions diagnosed and/or treated.

He said the boy has CF but that was all. The agent had no idea that CF was a progressive, fatal disease (at that time).

This agent was a regional manager with several agents under him, yet he had no idea why a carrier would not issue a policy.

This was many years ago yet it is apparent that today there are agents who have no idea how insurance works.

Don’t be so hard on yourself. You will figure out how insurance works eventually.

 

[LostDollar]

The mapd company pays the different drs just like your Medicare sup does . The clients responsible for the $90 bill for the emergency visit period .

So who determines what the providers that are not hospital employees get paid, the hospital or the MAPD company?

Do the MAPD plan holders get EOB's from the MAPD company, like the MEOB, that show the invoicing from the providers, the original charge and the amounts approved to be paid?