AgentGeneral
Guru
- 281
Are the part B injections ALWAYS 20% after negotiated price on an MAPD? Yes?
I'm still fairly new, going into 3rd year and hit a stage that I'm starting to do supps as a natural progression bc T65 referrals starting to hit a nice stride. Up until now, I haven't had to think too much about this bc my beginnings of career were highly focused on veterans and dual and long time MAPD people. 30% dual, 20% healthy and just wants MAPD period, the rest veterans and/or barely above dual.
I had a few new clients this past week with a specific condition: wet macular degen with part b injections and I have been hearing conflicting answers from experienced agents on this question along the lines of this:
One said, with wet macular degen it's "co-pay and diagnostics". Im pretty sure that's wrong. This 15 yr agent said it's different than chemo and is an eye disease and treated differently. Made no sense, it's still a part B injection. Any thoughts?
I heard from two others, "it's hospital co-pay, or doc co-pay" and that's it. These are 20 year agents. I don't like that answer, again, doesn't make sense, there's still an injection. Then again, some things don't make sense in this biz.
I've talked to billing depts, docs, agents, carriers, and I think this confuses more than just me. No one could answer it with a solid answer, although the billing dept person at a specialists office sounded the most credible. She said the injection for a specific case was $3300 and it would be negotiated down then 20%. But, what will it be negotiated to? No one could say. Same billing lady said if they only have OM, no supp, PDP, deep deep discounts on said 3300 injections.
The evidence of coverage isn't exactly clear, the one i read, page 78 and 60, doesn't even make sense. It says co pay on eye disease on page 70 and page 68 talks only about part b injections in the example of cancer treatment.
In my mind, it's doc co-pay or hospital outpatient co-pay and 20% of negotiated cost of Part B med which is basically what the billing lady said. Or is it what the other "experienced" agents said.
So bottom line do supp/PDP right? at least that's what the recommendation should be.
Anyone with wet macro degen clients who could shed solid light?
I'm still fairly new, going into 3rd year and hit a stage that I'm starting to do supps as a natural progression bc T65 referrals starting to hit a nice stride. Up until now, I haven't had to think too much about this bc my beginnings of career were highly focused on veterans and dual and long time MAPD people. 30% dual, 20% healthy and just wants MAPD period, the rest veterans and/or barely above dual.
I had a few new clients this past week with a specific condition: wet macular degen with part b injections and I have been hearing conflicting answers from experienced agents on this question along the lines of this:
One said, with wet macular degen it's "co-pay and diagnostics". Im pretty sure that's wrong. This 15 yr agent said it's different than chemo and is an eye disease and treated differently. Made no sense, it's still a part B injection. Any thoughts?
I heard from two others, "it's hospital co-pay, or doc co-pay" and that's it. These are 20 year agents. I don't like that answer, again, doesn't make sense, there's still an injection. Then again, some things don't make sense in this biz.
I've talked to billing depts, docs, agents, carriers, and I think this confuses more than just me. No one could answer it with a solid answer, although the billing dept person at a specialists office sounded the most credible. She said the injection for a specific case was $3300 and it would be negotiated down then 20%. But, what will it be negotiated to? No one could say. Same billing lady said if they only have OM, no supp, PDP, deep deep discounts on said 3300 injections.
The evidence of coverage isn't exactly clear, the one i read, page 78 and 60, doesn't even make sense. It says co pay on eye disease on page 70 and page 68 talks only about part b injections in the example of cancer treatment.
In my mind, it's doc co-pay or hospital outpatient co-pay and 20% of negotiated cost of Part B med which is basically what the billing lady said. Or is it what the other "experienced" agents said.
So bottom line do supp/PDP right? at least that's what the recommendation should be.
Anyone with wet macro degen clients who could shed solid light?
