My father in law was just solicited by a medicare supplement insurance salesman. I am leery of this.?

Question

How do I find out rankings of these companies, and, more importantly, is there a listing available somewhere of their ratio of claims made to claims denied? I am all for him getting some of the things this salesman talked about--IF he will actually get them when he needs them.

Answer 1

You should check out your agents companies.  You can do that by calling your the state insurance boards where the companies are located.  If it is Texas 800-252-3439.  My agent is located at http://www.lvhealthins.com he has been very helpful at getting my numbers for state agencies to check out companies.

Answer 2

Medicare Supplement insurance works differently than you are thinking so the "ratio" doesn't matter.

It's complicated but I'll give you the highlights. The way they work is: if your doctor codes a procedure as a Medicare covered procedure Medicare will pay based a upon pre-established fee schedule. If the doctor accepts Medicare assignment it means he agrees to charge what Medicare says he should charge. If he does not accept assignment he can charge up to 15% more than Medicare says. Either way, Medicare will pay the doctor the same dollar amount.

The doctor will then file with the Supplement policy. There are Supplement policy Plans A through L. Supplement policies are standardized so a Plan F, which is the most popular, has the exact same coverage no matter which company you get it through - the only difference is premium. What the Supplement pays depends upon which plan you have. Some plans will pay only the balance up to the assignment amount and some will pay the 15% as well. The supplement, depending on the policy plan, will pay for all Medicare approved procedures sent to them within that policy plan limits. They will not pay for any procedures that are not approved. Because of the standardization and the fact that Medicare will either first approve or disapprove a procedure means that 100% of all Medicare claims sent to any insurance company are paid at 100%.

A Medicare Advantage plan, which many people consider a Medicare Supplement but are not, is different. The plan must cover all procedures within Medicare guidelines but most will offer additional coverage. The additional coverage is up to the insurance company so depending upon the doctor coding some claims may not be paid. There is no listing available of the ratio.

As I said, this is just the highlights. If you don't trust what the salesman is telling you talk with an independent agent that works in the senior market and offers both Medicare Supplement and Medicare Advantage plans from different companies. Even though all Medicare Supplement plans are the same not all Medicare Advantage plans are. Both types have pros and cons and neither type should be considered the best for your father-in-law without comparing.