Tuesday, December 11, 2007


There's a lot of controversy going on in the insurance and health care businesses regarding Private-Fee-For-Service plans, or PFFS. As an insurance agent contracted with three companies regarding health care, especially for senior citizens, I have to know what's going on.

Okay, sure, I'm not 65 yet. That doesn't mean anything. If Medicare is falling apart now, I can only imagine what it'll be like when I retire. It almosts makes me want to NOT retire.

Back to PFFS. PFFS is basically a restructuring of Medicare benefits. There's Medicare Part A, Part B, and as of 2006, Part D (Prescription Drug Plan). The PFFS is like a Part C, also called Medicare Advantage. All you really do is enroll in these plans, and you pay a co-payment to the doctor.

Sounds great, huh? Sometimes. The biggest concern is that not everyone accepts PFFS. And that's the big controversy right now, at least in the NC-Triangle area.

With all these other providers (United Health, BC/BS, Humana, Pyramid), its not a regulated practice, and that's the beauty of it; no contracts to hospitals and health care providers. But because of the lack of regulation, PFFS plans are not paying in a timely manner, not paying a decent amount, and even denying claims. This is because PFFS is run by the insurance companies, not Medicare.

I wonder which presidential candidate will address this one.

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