PFFS plans

[Winter_123]

How does it work logistically when you have a client interested in a pffs plan but neither of you know whether his physician or a physician that he is interested in participates in the MA plan? What's the next move there?
You have to contact the physician or there is a look-up somewhere with the carrier or what? How does this work when you are at the clients house in the evening?

Thanks for any info.

Winter

 

[senior-advisor-indiana]

Take the app and call the physician before you submit it.

 

[allhealthandlife]

But that is a CMS compliance violation. PPFS are the most frustrating health insurance i have ever sold. Nothing like telling your client yep, General Hospital is accepting our Medi Ready Todays Mature Old Fart's Choice Gold Plus Senior Select Double Secret Private Fee For Sevice Part C Medicare Advantage Plan (Option Two ) only to have the hospital stop taking it a month later after lock in starts.

To many moving parts in an already overly confusing and complicated decision.

 

[senior-advisor-indiana]

I did not say to tell the prospect that thier doctor accepts the plan and then find out later. I meant, tell your prospect that you will take the app and call when the office is open. If the doctor says no then you do not send in the app. Of course you cannot take the app now unless they are aging in.

 

[allhealthandlife]

Actually taking an application and not being certain you are going to submit it is a violation.Not that i haven't ever done that but it is another way you can get yourself in trouble.

And oh by the way another thing that is a violation next year is you must use the term " No Health Plan Premiums" or the like. If you say " no monthly premium or no monthly plan premium " you are not compliant.

It seems like the Insurance companies don't want beneficiaries to fully understand Medicare Advantage and CMS doesn't want agents to "sell " Medicare Advantage.

I wish that CMS would stop using the label Medicare Advantage and just call these plans Private Medicare Insurance Replacement Plans and just get it out in the open.

 

[HoosierDaddy]

I did not say to tell the prospect that thier doctor accepts the plan and then find out later. I meant, tell your prospect that you will take the app and call when the office is open. If the doctor says no then you do not send in the app. Of course you cannot take the app now unless they are aging in.

Do you do this with every MA plan you write???? Wow, to me that is a lot of risk on your part... I can see the "STI" now from CMS....

"Mr. Senior Advisor told me that all my doctors accepted the plan and I went and seen a specialist and they did not except my MA plan. Now I have a 250.00 doctor bill. I don't know how I am going to eat this month. I have contemplated suicide. Why did that nice young man lie to me. I don't think it is right to take advantage of seniors, he should be punished!".... in my best *** old lady voice.....

That is the problem with marketing MA plans... The agent takes all the risk. First of all you are not dealing with the brightest people in the senior market. Then you have to hope the are paying attention to your presentation and instructions and not zoning out watching the 'Price is Right' on the blaring television set.

Then you have to hope that every doctor or specialist that they may ever see will accept payment from the plan. Then you have to hope that the company will pay the claims, and that the *** senior realizes that procedures have to be "medicare approved" I had one nasty old lady call me all upset because Secure Horizons did not pay when she went to the doctor to have her toe-nails trimmed.

It just seems that if there is any bumps along the road the client and the insurance company blame the agent. It seems that none of the other parties are held accountable for any problems that arise... But the commission's are good if they stay on the books.....

</IMG>

 

[HoosierDaddy]

Actually taking an application and not being certain you are going to submit it is a violation.Not that i haven't ever done that but it is another way you can get yourself in trouble.

And oh by the way another thing that is a violation next year is you must use the term " No Health Plan Premiums" or the like. If you say " no monthly premium or no monthly plan premium " you are not compliant.

It seems like the Insurance companies don't want beneficiaries to fully understand Medicare Advantage and CMS doesn't want agents to "sell " Medicare Advantage.

I wish that CMS would stop using the label Medicare Advantage and just call these plans Private Medicare Insurance Replacement Plans and just get it out in the open.

You are 100% correct... In fact I think they should allow people to enroll in a plan at their doctors, pharmacy, Social Security office, Walmart, Direct Mail ect. If this is such a big money saver for the Government and will "Supposedly" save Medicare then quit being so damn mysterious with the programs.

The should come up with 6 or so plans and standardize the benefits like they did Medicare Supplements. Those "know-it-all" insurance companies would be all over it.

 

[allhealthandlife]

Right on.Then insurance companies will have to compete on true efficiency instead of competing by designing plans with the most creative loopholes and glossiest vague brochures that are still able to get approved by CMS

My opinion is that since Wall Street only cares about the next quarter earnings forcast these publicly traded companies will milk this flawed system hard until Congress acts.

Did you know that international billionaire George Sorros's hedge fund has owned a big chunk of WellCare since the stock was trading at about 10.00 a share a few years ago ( before the 2003 Medicare Modernization Act)and now is trading at 117.00 a share. These guys know ahead of time( or pay to make it happen) when legislation is going to create a windfall for certain industries and corporations.