Actually, WellCare does not have a PFFS plan for duals. They sell the Duet plan that way, but it's just their regular PFFS that pays the same way Medicare pays at at 80%. They do eliminate the deductibles however (I think).Anybody know if there will be a dual PFFS Open Access Fee for Service plan for duals besides Wellcare?
Sounds like the Wellcare gal meant their plan pays 100% of whatever Orig Medicare would have paid....meaning, they pay the same amount as O.M. would have paid.
The following is correct for California but MAYBE not for other states.I can't speak to Wellcare's actual claim payments, because I am not contracted with them, but I will say that this explanation is the way it should work. Medicaid is always the payor of last resort, so if Wellcare is coordinated with them and is able to bill them after paying the required Medicare benefits, it appears copacetic.
Not everything works out as planned on paper. I have run into other plans that are supposedly "co-ordinated" with Medicaid, only to find out that they deny claims. Sometimes this is a problem with the case worker, other times it is because the plan is not set up properly, or does not disclose that the benefits are actually less than full Medicaid benefits.