Accepting Med Adv but Not Medicare?

[medsuptage]

Hello all,

I'm relatively new to the insurance field/ sales in general. I've been doing this for about 4 months and have actually been relatively successful.

Anyway, I was curious if anyone knows the legality of a Clinic accepting medicare advantage plans but not accepting Original medicare (and of course, med sups).

I have a local clinic that is a complete powerhouse that doesn't accept my companies med advantage plan so I have written many clients for med supps because of that. Now the clinic is saying they will not take original medicare only specific med advantage.

So I'm looking at MASSIVE!!!! charge backs for doing absolutely nothing wrong but doing my job to the best of my ability, following management instruction, and selling med supps to these clients.

I work out of Washington state, if that matters. Is there any direction or information any of you veterans could provide me on this matter?

Thank you so much!

 

[ksigmtsu]

A doctor can decide what they're going to accept for payment at any time, barring contract issues, and even that would be completely out of your control. The only thing you can do is go get contracted with the MA plan, and offer your clients alternatives, rather than lose the clients.

 

[medsuptage]

A doctor can decide what they're going to accept for payment at any time, barring contract issues, and even that would be completely out of your control. The only thing you can do is go get contracted with the MA plan, and offer your clients alternatives, rather than lose the clients.

Thank you very much for the information, That unforunitly is extremely bad news for me..

I would love to contract with the Ma plans they accept. However I am an exclusive agent working directly for an insurance company.

 

[Josh]

That rots, but that's sort of just how this goes. Thank you Obama, change we can believe in!

 

[medsuptage]

That rots, but that's sort of just how this goes. Thank you Obama, change we can believe in!

lol you said it!

 

[djs]

Like it or not, this situation has little to nothing to do with Obama.

My recommendation? Call the clinic and see if you can work with them to take original medicare. Its a long shot, but you might be surprised. Worse that can happen is you find out why they have taken this stance, which would help you understand the motivation and explain it to your clients.

Is there only one clinic in town? That seems odd. I know individuals like their doctors, but how come this one clinic is such an issue?

Dan

 

[Josh]

Like it or not, this situation has little to nothing to do with Obama.

Except for the part where it does. This "healthcare reform" bill cut already relatively low provider reimbursements. That has put some providers over the edge and made it so they will no longer accept original Medicare. I bet the reason why they'll take some MA plans is because they are getting a better reimbursement and it strictly is about dollars and sense. The only sensible thing for providers to do if they need to get higher reimbursements is to play "lets make a deal" with a carrier and do exactly what they did. That has everything to do with Obama "making medicare more sustainable".

 

[medsuptage]

Like it or not, this situation has little to nothing to do with Obama.

My recommendation? Call the clinic and see if you can work with them to take original medicare. Its a long shot, but you might be surprised. Worse that can happen is you find out why they have taken this stance, which would help you understand the motivation and explain it to your clients.

Is there only one clinic in town? That seems odd. I know individuals like their doctors, but how come this one clinic is such an issue?

Dan

This clinic is a powerhouse its been around a long time has a record for above and beyond excellent care. Clients are extremely loyal to the clinic. The Clinic has contracted with med adv providers to pay above and beyond what original medicare pays in exchange for what apprently is better incident by incident care which in turn they claim keeps the clients from having to use the clinic as often... I work for Sterling Life insurance company and we were late contracting for our MA plan to agree to these terms and I guess now their going away with Original medicare completely unless they were grandfathered into it years ago.

Basically they have built such a strong and loyal client base they know their clients will do what ever it takes to stay at the everett clinic. So the everett clinic I guess is only going to accept these contracted MA plans that agree to pay to their terms.

 

[briangruss]

I work with plans that the Everett clinic accepts, however I do believe they work with original Medicare (according to their website)

 

[G.Gordon]

A clinic that accepts MA, but not medicare... never heard of that animal before. Have you had a conversation with the clinic? Someone higher up the food chain than the "insurance girl".

I don't do MA at all, but I also thought that one requirement of a provider to accept MA was that they also accept original medicare. Am I wrong? Was that those PFFS plans? For some reason I have this in the back of my mind.