Medicare Replacement Insurance? (Cont.)
Notes from the Medicare Marketing and Sales Podcast Episode 74
Part 2 of 2
In the first post we talked about billing offices (you can read it here).
Besides billing offices, there is another group of people who may have something to say about Medicare Advantage plans. These are the hospital discharge planners, hospital and nursing home social workers, and others who are involved in moving someone from a hospital setting to a skilled nursing care center.
Why would they not like Medicare Advantage plans? Here ya go:
Restrictive networks - With OM, they have all the facilities at their disposal. With a MA plan, they have to follow the network which can be difficult when there is a shortage of available beds.
Pre-Auth - Pre-Auth is required with a lot of MA plans. With OM, in many cases as long as the coding is correct they are good to go. With MA plans, they need to coordinate the care and that can add extra work and challenges for the facility.
RUG Rates - Resource Utilization Group rates are the coding for skilled facilities. Under MA plans, the patient/your client may not be authorized for a higher RUG rate, which can reduce the reimbursement rate for the facility.
Just like with the billing office staff, you don’t want to come in guns blazing and tell all of them why they are wrong, as they may dislike Medicare Advantage plans, and now they are going to dislike insurance agents too. It is important to remember they don’t see all the other benefits of having a Medicare Advantage plan, like the low to no premium, the maximum out-of-pocket, the ancillary benefits, etc. They are only seeing the restrictions that are put in place making their jobs harder.
No insurance plan is perfect, and while the see the negatives, show them why clients like Medicare Advantage and all the other features and benefits. Acknowledge that yes, Medicare Advantage plans may make their jobs harder at times, but the overall plan is helping people. Be an ally, not an enemy.