Reasons for chargebacks?

[fostever]

What are the steps to help someone apply for dual eligibility?

Mike

If they are on a fixed income of around $800 or less, $1100 for a couple; then we ask them if they ever applied for medicaid. It may be more, those were 2005 levels. If they enroll with us our customer service does an outreach. If they think they might qualify, we send them the state form to enroll. If they qualify, we switch them to our dual eligible plan.

 

[honestagent]

Yeah I know. I shy away from dualies,but have about 25 who have been on the books for a couple years. We help them apply for dual eligibility when they join our MAPD and then move them into our Total Care plan. It covers everything at zero co-pay and extra benefits like transportation, cash in an account to pick medically related items from a members only magazine, and other extras. Our state is 100 days behind to pay out for medicaid claims so alot of private practices are not taking medicaid people. Lately I've been following a former agent who used to be with my regular MA plan. He goes in and switches them to his new crappy plan with $195/day-20days co-pay for inpatient hospital (no annual max.) I show them $175/day for 3 days($1500 annual max) and it's a done deal. He tells them the plan just changed names and to sign here for the new years benefits. During AEP the last agent to sign them gets the client. These people are really grateful and are good referral sources since they know others in the hood who had seen this jerk. He used to be with Humana and spent 2 years switching his book of business to our plan. Now he is with Secure Horizons and moving them again. Real creative, huh.

Hi. I'm very curious to know what company/ies you represent? Are you an indy?

 

[MAPDJim]

However, Secure Horizons REPLACES Medicare with private insurance. It doesn't pay the 20%, it doesn't pay the deductible, it is no a "can-only-win" situation. The benefits are per their policy and in no way does it interact with Medicare. In fact, Medicare basically does not exist as far as paying any claims.



I found this forum today and it's great to see the ideas and info posted that are certainly helpful to me.

As far as your response to the gentleman who posted about the MA-PD plans and how they work.

Wouldn't it be safe to say he was on the right track but just worded it wrong?

As I embark on my MA career this week (have worked in the senior market for reverse mortgages) the MA-PD plans I am going to market with have no 20% coinsurance (replaced with copays, i.e., $15 doctor visits) or deductible for part B. (no deductibles or premiums for A/D as well.) Connecticare in case you are wondering. (located in CT)

Given that the MA programs have to offer, at the very minimum, everything Medicare offers, (of course they offer more, hence the Advantage name) wouldn't you also say they are just having their Medicare benefits administered by a private insurance company? The doctors do what they did before and the private insurance companies process things (besides sticking their noses into claims with HMO's)

What I'm getting at is this. I think he had the right idea but just needed to reword it for the consumer.

One question I did have that I can get answered tomorrow but was wondering if you guys knew today.

As far as this goes:

In-Network
For Medicare-covered hospital stays:
Days 1 - 7: $200 copay per day

In some plans I've seen Part B drugs either a $45 copay or 0-20%. This would be located in the drug presciption area of the MA-PD's.

My question is this. If you don't see any mention of the part B drug copays or any part B copays can I assume there are none. (hate to assume)

In other words would a 7 day hospital stay cost me $1400 (like the above plan) with no part B copays (extras from hospital stay)?The plans I've looked at make no mention of this.

Thanks in advance.

 

[honestagent]

If you can get your hands on a copy of the EOC (evidence of coverage) per program per carrier, all of your assumptions will no longer be those... assumptions.


They're not always easy to get; some carriers offer a viewing of them on the internet and this should help you with your questions.

As for non networks, copays are usually mostly higher.. how much? Copays will vary depending on program, facility, how claim is billed, and the procedure. Let me say this: Enough to get a pissed off client calling you saying...'you lied to me' if the senior did not understand 'network' and 'copays' and how all of this works! If your customer understands that he/she has to play by certain gameboard rules when joining a MA Plan, (with the most important of all is: must go to docs that are in network or docs who accepted 'deeming' process) then you should have no bad hangovers after your sale.

 

[lonestar]

.

The Concert is a PFFS MAPD. It is my understanding that Wellcare has HMO plans for duels.The Select plan for those on partial assistance and Access for fully duels. Also on the FFS side a plan specifically for Duels, the Duet plan. Which one is inappropriately marketed?

 

[honestagent]

I wouldn't necessarily say 'inappropriately marketed.' To his or her own opinion.

I'd say poorly marketed to the powers to be = to the mass = providers!!! Most issues encompassing these plans stem from the lack of knowledge and how the infastructure within each flavor of MA and or MAPD is.