Humana Gold Choice Balance Billing

[Cenla Agent]

Is Humana Gold Choice a good plan for me?


The summary of benefits for Gold Choice this year mentions balance billing, which wasn't there in previous years. Does this work similarly to how the limiting fee works with providers who do not accept assignment.

Also, is this a facet of all PFFS plans now?

Thanks

 

[dandan]

This was brought up in a recent delegated agent training, they denied that the Doctors could balance bill. They tried to explain it as CMS wording and that it couldn't happen. I believe Yes if assingment is not taken they can balance bill.

 

[Cenla Agent]

What a bunch of bs. No wonder you said it is for the birds....

 

[Cenla Agent]

The reason I asked the question is that it doesn't make sense. I thought for a provider to accept PFFS they had to accept the plans terms and conditions, which meant accepting assignment as well. But this language about balance billing suggests otherwise.

 

[dandan]

It is my understanding that with any PFFS company balance billing is allowed if the Doc doesn't take assignment. I am sure greensky can clear this up.

 

[Cenla Agent]

Here is the language from the Gold Choice S.O.B.

The language about "out of network" in the same sections is indeed some gobbledygook that doesn't apply since PFFS has no network. But I'm not buying what dandan reported from the delegated meeting. Dan, were these Humana managers or FMO people?

Balance billing means that a provider may
charge and bill you more than the plan’s
payment amount for services. There is a limit
on what providers may charge for
Medicare-covered services.
• Providers may balance bill 1% to 15% of the
plan payment amount for the following
services:
– Doctor office visits
– Chiropractic services
– Podiatry services
– Other health care professional

There is no further explanation in Section III either.

 

[dandan]

It was in the Atlanta Humana office, No FMO it was in a training class with around 20 other agents. I just explained to you what was told to the room. When another agent questioned the excutive he got hot and said it was true they could not balance bill.

 

[senior-advisor-indiana]

So what is it dandan? They can or can't balance bill? You have said both.

 

[dandan]

Well, I think they can, and that is the only thing that I have said.

 

[Cenla Agent]

So what is it dandan? They can or can't balance bill? You have said both.

The Summary of Benefits says they can. I guess it's similar to Part B "excess".