- Thread starter
- #21
I t is a case of the hospital not being paid with an MA. It all happened but how do you suppose that it is because I need to make lifestyle changes. You don't know anything about my lifestyle.
Selling MAPD? Hear From the Provider Side
- Thread starter rousemark
- Start date
I am relatively new to Medicare sales, only 12 years, but have dealt with managed care plans, directly and indirectly, for over 30 years.
Access to care is a BIG deal . . . the problems with access to care almost always become evident when you really NEED care.
One of my clients was very difficult to work with. A real PITA . . . so much so she refused to talk to me and had her husband communicate her wishes.
Soon after Obamacare was implemented she changed policies . . . the carrier she had for years was exiting the market which created a closed book of business. Knowing there would be big rate increases in the future, I suggested changing plans. Her health was good at the time.
I had always had good experience with KP for under 65 health insurance. Even folks who said they would NEVER have an HMO loved the plans and never left. She moved to KP.
A few years later she was diagnosed with a very rare kind of cancer. So rare she was admitted into an NIH study. Most of her bills were covered by NIH but she had a horrible time getting KP to agree to let her go to Bethesda for evaluation and treatment.
She lived much longer than expected and when she was turning 65 she asked for my help and said "Get me the hell away from managed care"
So I wrote a Medigap with Anthem.
She is still alive, still complaining (but mostly about her health), but she has NO complaints about access to care, nor the fact that Medicare + Medigap covers all her bills except the B deductible.
Access to care is a BIG deal . . . the problems with access to care almost always become evident when you really NEED care.
One of my clients was very difficult to work with. A real PITA . . . so much so she refused to talk to me and had her husband communicate her wishes.
Soon after Obamacare was implemented she changed policies . . . the carrier she had for years was exiting the market which created a closed book of business. Knowing there would be big rate increases in the future, I suggested changing plans. Her health was good at the time.
I had always had good experience with KP for under 65 health insurance. Even folks who said they would NEVER have an HMO loved the plans and never left. She moved to KP.
A few years later she was diagnosed with a very rare kind of cancer. So rare she was admitted into an NIH study. Most of her bills were covered by NIH but she had a horrible time getting KP to agree to let her go to Bethesda for evaluation and treatment.
She lived much longer than expected and when she was turning 65 she asked for my help and said "Get me the hell away from managed care"
So I wrote a Medigap with Anthem.
She is still alive, still complaining (but mostly about her health), but she has NO complaints about access to care, nor the fact that Medicare + Medigap covers all her bills except the B deductible.
XpressInsurance
Super Genius
- 244
I don't know anything about your situation, it sounds like a very bad. Again, if it was me, I would be happy that I was alive. My final wishes are not going to about what my insurance is paying the hospital or providers. My focus would be on my family.
Your statement implies he isn't happy to be alive or his focus isn't on his family. Believe it or not, you can be happy that you don't have to worry about network issues in his situation while also being happy to be alive and focusing on your family. The discussion here is about network issues and care and not about being grateful for life and family.
I'm sure he is very happy to be alive! I'm also pretty sure he is very happy that his bills will get paid and he doesn't have to worry about trying to pay for them, while he is still alive.
You keep saying, "final wishes" as though he didn't make it....geez!
XpressInsurance
Super Genius
- 244
Access is the rare exception not the rule. I have written a lot of policies over decade plus, I rarely hear about access to providers. I also contact my customer base multiple times per year. I hear more about Medicare Supplement premiums than anything, not access to MAPD providers
I don't think most doctors know what they are paid from insurance companies. I think in this age most are employees for hospitals or groups.
Everyone has opinions about MAPD vs Med Supp. Nobody is going to change anyone's mind.
Great, but you didn't actually address what I said. You certainly don't have to if you don't want to.
XpressInsurance
Super Genius
- 244
Sure people can be happy and glad the bill is paid without network problems. Given the situation I don't think even with a Med Supp his current situation is any better. On the list of shit to think or care about in his situation, this is not where I would focus.
If you want me to address lifestyle. I think men, tend to wait too long to address problems. I am a type 1 diabetic, I control my blood sugar by what I put in my mouth. Ask a underwriter why Medicare Supplements are more expensive for men vs women, even though women go to the doctor more often. I have know a lot of people who ended up in dire situations because they failed to address problems years before. Again I do not know him, but the least of my personal concern would be who paid the bill. You may think I am crazy for that but who cares.
Again, you imply he isn't concerned about other issues. He addressed the topic of the thread. I'm quite certain if the topic of the thread was "what would be most important to you in this circumstance", he would have likely said being alive and his family. But because that wasn't the topic of the thread, he addressed how his current situation falls under this topic. For some reason, you appear to believe because he did that, it obviously means he isn't grateful to be alive and isn't worried about his family.
Nowhere did I ask you to address lifestyle issues, but you do you man.
XpressInsurance
Super Genius
- 244
I did not imply it was his only concern.
His situation sounds bad. This again if it was me, who pays is not even in the top 1000 things I would be concerned about. I would be doing lots of other things in life including not reading or posting on this forum, but that is me.
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