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UHC – consumers enrolling in a DSNP

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You must advise consumers enrolling in a DSNP that:

They are not required to pay copayments for Medicare-covered services received from a DSNP network provider if they are Full Dual-Eligible or determined DSNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program.

 

You have approached a hospital administrator about marketing in her facility.  The administrator is uncomfortable with the suggestion.  How could you address her concerns?
Tell her that Medicare guidelines only allow you to conduct marketing activities in areas of the facility where individuals are waiting to receive health care services, but not in places where they would be receiving health care such as an examining room.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him?