Ah...The 'Crisis' Continues.......

[csx4910]

Both of you have some valid points but just to add another opinion - I am a heath care professional (Respiratory Therapist) who own a durable medical equipment company (paid under part b) My insurance salesman you are quite wrong that the Medicare replacement plans(or whatever cool name you all want to give them) are not HMO's. They are much closer to the HMO family at least on the on the part B side than a PPO plan. The medicare replacement plans are NOT open to any medicare participating provider, since they give exclusive contracts to the lowest bidder to increase their profit. They restrict the Medicare patient from their choice (a Medicare hallmark) The contracts are capitated meaning that the provider is paid by the # of members a certain dollar amount whether they provie nothing, a beside commode, or a $15000 power wheelchair. The incentive is for the providing company to provide the least amount of service possible to maximize profit and to keep the costs fixed for the insrunace compnay. Often, senoirs find out too late that their premiums are higher with less coverage than they had with Medicare.

You sell the plans - we have to deal with what the reality of reimbursement with Medicare and the other plans after the fact. Would you be so hot to trot for these if you didn't receive a commission for them? What if you got a commission for selling Medicare? Would that change your story? And by the way, If I am signed up as a medicare provider I will NOT get paid if I treat and provide equipment for a Medicare patient.( I am not sure where you pulled that one from!)
Ron
Valley Respiratory Services

[Dan40]

Originally Posted by csx4910

Both of you have some valid points but just to add another opinion - I am a heath care professional (Respiratory Therapist) who own a durable medical equipment company (paid under part b) My insurance salesman you are quite wrong that the Medicare replacement plans(or whatever cool name you all want to give them) are not HMO's. They are much closer to the HMO family at least on the on the part B side than a PPO plan. The medicare replacement plans are NOT open to any medicare participating provider, since they give exclusive contracts to the lowest bidder to increase their profit. They restrict the Medicare patient from their choice (a Medicare hallmark) The contracts are capitated meaning that the provider is paid by the # of members a certain dollar amount whether they provie nothing, a beside commode, or a $15000 power wheelchair. The incentive is for the providing company to provide the least amount of service possible to maximize profit and to keep the costs fixed for the insrunace compnay. Often, senoirs find out too late that their premiums are higher with less coverage than they had with Medicare.

You sell the plans - we have to deal with what the reality of reimbursement with Medicare and the other plans after the fact. Would you be so hot to trot for these if you didn't receive a commission for them? What if you got a commission for selling Medicare? Would that change your story? And by the way, If I am signed up as a medicare provider I will NOT get paid if I treat and provide equipment for a Medicare patient.( I am not sure where you pulled that one from!)
Ron
Valley Respiratory Services

Try rereading from the top and add comprehension. IF by Medicare replacement plans [A TERM NEVER USED BY ME] you mean the actual HMO's a person can choose instead of Medicare. Then yes, they certainly are HMO's. If you mean any of the 10 standard Medicare Supplemental Plans, then no they are not HMO's. There is an alternative to the 10 standard Medicare Supplemental plans that is somewhat PPOish. Most of them are the same for part B, but have a participating hospital list under part A. These PPOish plans are called Medicare SELECT plans.

Then there are Medicare ADVANTAGE plans

From Medicare

Medicare Advantage Plans (like an HMO or PPO) See page 6.
• Run by private insurance companies approved by Medicare. • Provide your Part A and Part B coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Costs for items and services vary by plan. • If you want drug coverage, you must get it through your plan (in most cases). • You don’t need a Medigap policy.

Those plans might be your complaint, or maybe your complaint is that Medicare [not Medicare supplemental insurance] pays according to a fee schedule. If so, that is the US Govt's plan not any insurance company plan.

Also from Medicare:

Types of coverage that are NOT Medigap policies
• Medicare Advantage Plans (Part C), like an HMO, PPO, or Private Fee-for-Service Plans • Medicare Prescription Drug Plans (Part D) • Medicaid

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXX

A standard Medigap or Medicare Supplement plan and the Medicare Select plans ALL pay 20% of the Medicare approved amount [fee schedule] for PT and/or durable med. equipment. They are in no way involved in determining Medicare's fee schedule. If Medicare itself approves $200. the supplemental insurance pays $40. They do not care what the retail value could be, they do not determine if Medicare is over or underpaying for the treatment. They have to pay 20% of the Medicare approved amount.

[csx4910]

But you still didn't answer my question of how much of a commission you get for selling them and would your answers change if you were able to "sell " people to sign up with straight Medicare?? Obvioulsy your bias is slanted on how you get paid. Nothing wrong with that but at least be honest with us (and yourself) in admitting it. You dont know the first thing about dealing with Reimbursmeent and payment from Medicare if you actually haven't done it.

[Dan40]

Originally Posted by csx4910

But you still didn't answer my question of how much of a commission you get for selling them and would your answers change if you were able to "sell " people to sign up with straight Medicare?? Obvioulsy your bias is slanted on how you get paid. Nothing wrong with that but at least be honest with us (and yourself) in admitting it. You dont know the first thing about dealing with Reimbursmeent and payment from Medicare if you actually haven't done it.

Of course I got paid, that is a given. Same as you get paid for what you do. I'm happy to help people for money. No money, they're screwed.
Reimbursement from Medicare and non-Medicare Insurance Companies, I probably know more about it than you do. The other half of this household is a semi-retired consultant on just that, Reimbursement! I even know how to spul it. Before retiring my wife ran medical billing companies and has held the position of Chief Financial Officer of a large hospital and the same position in a large hospital chain.
I sympathize with you about The Gov't. run Medicare reimbursement rates. I have held in my hand many times the actual 'schedule of benefits.' and saw that it often times is ridiculously low. But that, not Medicare Supplement Insurance is the source of your complaint. As previously stated, they must pay 20% of the Medicare approved rate and they do not get to determine that Medicare rate. The Gov't. does.
In "normal" insurance, many people complain about long waits to be paid. Homeowners, auto, non-Medicare health insurance, even life insurance. That is because the companies must investigate the claim to verify that it is real and they must pay it. They won't if they can get out of doing so.
But not in a Medicare Supplement. Medicare determines if the claim is payable and notifies the insurance carrier of their responsibility to cover the 20%. Investigation over!
I also sympathize with you about HMO's [And I could have made 2.5 times more commission selling HMO's, BUT NEVER REPRESENTED ONE] The reason? In our area more than a dozen Medicare HMO's came in, signed up VERY few Doctors, none of the 'known Doctors' and eventually closed their doors. When they first started up I told some of my poorest clients to drop their supplement [that I was receiving a commission on] and to join the HMO, reason no premium and Rx coverage. I did not sell them or make money, I lost commission. Then the performance of these HMO's made me regret giving 'free advice'. They instituted premiums for coverage period, and higher premiums for Rx coverage and then they close up and the people are left terrorized with no Supplemental coverage. [I was never a good enough salesman to convince people that they did NOT need what EVERYONE else said they MUST have] So after a year or 2 in a HMO they had to get a new Supplement. Scenario: Senior buys Med Sup at age 65, his "attained age." He will be 65 forever with that company. Keeps his coverage for 3 years, then drops it to join a HMO. 2 years later the HMO folds. Now he buys a Med Sup again. Now his "attained age" is 70 and he with pay the premium for 70 forever with that company. [even if it was with his first Med Sup company.]

And in agreement with BOTH of you, I have often said that the care a senior receives under Medicare is terrific, but ONLY because the low paying Medicare is propped up by the in place, for profit, health care system we all now enjoy. Your non-Medicare patients pay you enough, or nearly enough, to allow you to treat the low reimbursement Medicare patients. A total Gov't system takes over and all reimbursement would be at those low rates which means you would be selling real estate, or UGH, insurance, or building Cobras, or selling shoes. But you would not be able to afford to be in the medical business.

I have never said a word about Medicare being a good financial plan, only that seniors get good care. Which is a compliment to both of you.