Coventry MA Claims Gone Wild

MedSuppPro · 09-05-2008, 08:59 PM

What is with these Sick-o’s?

If your client goes into a hospital with an infection that requires IV antibiotics, how in the hell can an MA plan pay for everything except the medication received in the hospital? Coventry says they don’t cover prescriptions in the hospital. Really! Medicare does. Is your client supposed to walk down too the corner Walgreens with a pick-line and PartD ID card.

Then a client whose only encounter with the Coventry plan goes to get her teeth cleaned and has x-rays. Coventry then sends her 25% of the total costs when the contract reads 50% of the UCR. Problem is, she then calls around and discovers that she went to the cheapest dentist in a 50 mile radius.

And I could go on…

They are denying claims that will only piss the providers and clients off.

Am I the only agent having problems with these jokers?

patch36 · 09-05-2008, 09:53 PM

I haven't had any issues yet. I didn't start selling Coventry until Feb, but have 60 or more on the books and no complaints so far. It is a regional plan and maybe that is a difference.

I hope there are no problems. It is a zero dollar monthly premium for a good ppo plan with low copays. I am not sure how they can do what they do in view of what the other MA's are charging here, so I worry they will cut corners on the claims.

*midwestbroker* · 09-06-2008, 10:26 AM

I have never heard of that either.

I have only had maybe a handful of problems with bills being paid. All were a coding problem. A simple call to the provider and it was resubmitted and paid.