- Hi, I'm Sylvia Gordon,
- And I'm- - This is my sister.
- Why are you saying this is my sister?
Because we're seeing, remember?
- Oh, because it's Sisters of Selling.
- Yeah.
- Hi, I'm Rebecca Gordon and I'm her sister.
- And we are the sisters of selling.
(both laugh)
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- Oh we'll get it, we'll get it.
(Sylvia laughs) - All right.
Let's talk about CMS.
They are gonna be boosting hospital and ambulatory,
which is a hard word, I think, to say, ambulatory.
Surgical rates, those are gonna be increasing
by 2% this year as well as home healthcare rates
by about 2.6, but...
(Rebecca drums on table)
- They're cutting doctor reimbursement rates by 4%.
- That stinks.
- So... (laughs) expect more doctors to
not accept Medicare assignments.
Right now, you know, most of the country,
it's like over 86% of doctors do accept Medicare assignment.
I sell a lot of plan N so I have to talk about this a lot
and there's like, 11 states that outlaw Medicare excess.
So Ohio, that was the first one.
But if you wanna know those states,
ask us in the comments and we will tell you.
I do not have it memorized
but I do have it on my bulletin board at work.
- It's like Washington, California...
- Yeah, it's like, yeah.
I sell a lot of plan in because of plan N,
but I sell N in states that do have excess
because most doctors accept Medicare assignment.
But when they keep getting pay cuts...
- Oh gosh.
- And they already get paid less,
more of them will opt for the excess charge
where they can charge 15% above what Medicare allows.
So prepare for that little bit of fun, those of you that-
- Sounds really fun. - Yeah.
So if you sell Medicare supplement and you'll only sell
plan G, of course it's not gonna hit you.
We expect plan D to be re-surging this year
and D is the same as the G but it has the excess.
Um...
What are you gonna do?
If you were a doctor, you'd probably do the same thing.
Say if I can get 15% more, I'll get it
because it's ridiculous, I don't wanna go backwards.
- Right, right.
- Let's talk about the step therapy.
- Oh my God, this has been such a pain point with clients
being told they get a prescription from their doctor,
they go to the pharmacist, pharmacist says,
can't give you this one,
insurance wants you to try this one first
and people have no say in it.
What can the client do?
- So people call it fail first, so...
- Who knows? - Think about it.
Think about this.
I have a drug that my cardiologist said that in her opinion
would best keep my blood pressure under control.
Then the insurance company goes,
"Nah, we want you to try this cheap one."
And how do you find out that the cheap one doesn't work?
You gotta take it
and it's gotta not work.
- Right. - Which is dangerous, right?
- And it's your heart. - You could have a stroke.
Right? You could have a stroke or a heart attack, right?
- Who the heck would do that?
- So they're calling it fail first.
I gotta prove this won't work,
which is a dangerous equation,
before the insurance company will give me the expensive one,
which is funny because our mom-
- My God, so it doesn't work,
you're back in the hospital, right?
- Or you could be dead. - Or you could be dead.
- You could have a stroke or a heart attack, yeah.
- Our mom.
- Yeah, so mom, they prescribed her Eliquis
'cause she just had open heart surgery
and so when she said Eliquis,
I was like, "Oh God, good luck."
Because Eliquis is very expensive.
It can be like 500 bucks a month.
For a designer blood thinner
versus Coumadin, which might cost five bucks a month, right?
Which has been around since the thirties.
- Coumadin, Coumadin. - Right? So... (Sylvia laughs)
I didn't say anything, 'cause I was like,
hope you enjoy that Eliquis they're giving you
in the hospital, 'cause I'm probably getting you
off that when you come home.
But we're all dealing with this.
I get calls all day long from mad clients saying,
"My doctor said I need this one,
the insurance company won't give it to me.
What can I do? What is a step therapy?"
And that's... it's...
- And that's everybody,
that's younger people and older people.
I've had that happen to me after a surgery.
My doctor wanted to prescribe me like a sweet drug,
like a good stuff.
He said at the very end if they don't cover it,
you could have this, and I am in pain.
I have a very low pain tolerance
and sure enough, when I got up there,
they wouldn't let me get it.
- Right, but you guys,
before you jump on the insurance companies,
they're not necessarily the culprits here.
A lot of the doctors, Google it if you don't believe me,
they get financial incentives
which the AMA has come out against
but it still happens to this day,
to prescribe a certain number of drugs.
They prescribe it.
They get to go to Atlantis
and stay in The Bahamas for a week
as long as they give a one page...
- Court-side tickets at the Lakers.
- They do a one paragraph speech that it's based on
that they prescribe so much, and I'm not saying Eliquis...
I'm not saying Eliquis has this kickback thing,
but it's very prevalent still in medicine.
So the insurance companies are trying to counter that,
the doctors that have a financial incentive
to prescribe expensive drugs, and if it's super expensive,
they can afford to give the doctor and his wife
these trips to Hawaii, right?
So the insurance company's trying to
break that financial incentive
when that drug might work just fine.
But it looks like the insurance company is just
being greedy, a lot of times it's the doctor being greedy
by trying to put you on that drug.
Now, the doctor should have tried you on some of these drugs
that are more affordable to you and the insurance company.
- Wanna give a vote up to Humana for my super cool swag?
- Yeah, this episode is now sponsored by Humana.
- And super cool Mike Jones, nice.
- We love Mike Jones, does a great job for us.
One of our best reps, best relationships.
- Awesome. - And he's a vet
and so he really helps us on their vet initiative
with the Humana honor program, which is something
that's very near and dear to our hearts.
So thank you Humana.
Thank all of you for tuning in.
See you next week.
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