3rd world or 3rd party?
Aetna - Not Extending NON GF Policies
- Thread starter Yagents
- Start date
3rd world or 3rd party?
BCBSTX did this last year.
It was to "explain the policies and benefits". What they were really trying to do is determine the claim liability. Questions included: Do you smoke? Are you prego? Any surgeries in the last 5 years? Any health issues we haven't discussed? What prescriptions have you taken in the last 5 years?
And they NEVER went away. (Please note. I was not screaming by using caps. Just making a point). They kept calling the policyholders until the interview was completed. I let my clients know ahead of time, so they were expecting the call and would respond.
- 8,448
It depends on what company AETNA contracts with, LOL.
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KGMom, I know what you're referring to. Our BCBS-IL does this now with every enrollment, but it's by telephone.
What made the AETNA letter different is that they're using a 3rd party to conduct IN-HOME interviews. Here's an excerpt from the Q&A portion of the AETNA e-mail...
"Q. Do members have to complete the assessment in their home? Can they go to another location?
A. In most cases, our vendors do not have a location in the member's area where he/she could go to complete the assessment. However, we usually find that our members prefer the convenience of completing the assessment in their own home."
ac
HOLY S**T!!!
Absolutely not. Under no circumstance do I allow people into my home that I do not know. If they told me it was a requirement, I would cancel my policy.
Email going to my Aetna rep now. If Aetna is doing this in Texas, I won't sell it.
Check your inbox KGmom...for an Aetna email dated Oct 23, 2014 (afternoon).
Q. Are members required to take these health assessments? If they decide not to, will they lose their coverage or will their premiums go up?
A. While we strongly encourage our members to take advantage of this opportunity, because of the benefits it offers them, they are not required to participate in the health assessment. Their coverage and premiums are not impacted if they decide not to participate.
Edit:
The email actually came in from "Individual Pre-65"
Q. Are members required to take these health assessments? If they decide not to, will they lose their coverage or will their premiums go up?
A. While we strongly encourage our members to take advantage of this opportunity, because of the benefits it offers them, they are not required to participate in the health assessment. Their coverage and premiums are not impacted if they decide not to participate.
Edit:
The email actually came in from "Individual Pre-65"
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Well. I just looked and I don't have it.
On the plus side, this reminded me to check my spam folder. Which was full of emails from Humana and Blue Directions. So thank you!!!
Guess I get to call the chuckleheads at Aetna tomorrow.
Email from Aetna below.
This is actually only a minor annoyance for me.
The non-continuation of NON GF policies is my biggest headache with them.
They are auto-enrolling clients into new 2015 plans that do NOT appear to be "comparable" coverage.
For instance:
$2500 deductible with $35/$50 CoPays. Paying about $650/month right now.
Auto-enrolling into a "Bronze Plan with $20 CoPays". Quoting them $550.
They don't tell them what their 2015 deductible will be.
They don't tell them that the 2015 PPO network will be MUCH smaller.
Client calls me saying that it sounds like a great deal.
No transparency allowed before November 5th, I guess?????
********************************************
Aetna Email dated Oct 23rd:
Client outreach for in-person health assessments
The Affordable Care Act is changing the way consumers engage in their health care. More and more consumers are entering the health care system. Many of these individuals have not had access to coverage for some time. They may not be aware of their current health needs or how their new plan can help them manage their care.
Recognizing this need, we continue to explore ways to engage to our Individual and Small Group members. Beginning this month, we will be reaching out to these members with an invitation to participate in an in-person health assessment. In most cases, the health assessment will be conducted in the member's home. In certain locations, members may also have the option to complete the in-person assessment at a local clinic, if there is a convenient location near them.
The information gathered through the health assessment will help us work with the member's primary care physician (if they have one) to coordinate their care and also identify if they are eligible for any of our care or disease management programs.
Outreach will begin this October and expand as we move through the rest of 2014 and into 2015.
Member outreach overview
Members will initially receive a letter from one of our vendor partners letting them know that this service is available and that we will be calling to answer questions and schedule an appointment with them. There is no cost to the member for this service for our Individual and Small Group members. While we strongly encourage members to take advantage of this opportunity, members are not required to participate in the health assessment.
As part of the health assessment, a licensed credentialed health care professional will review the member's current health status, medical history and current medications with them.
The information gathered in the health assessment will be used to gain a more complete picture of the member's health. We will also share the information with their PCP, if the member has one designated. This information can also help us identify if members are eligible for any of our care management or wellness programs.
Have questions? We're here to help.
You'll find some FAQs below that can help answer any questions you have. If you still have questions, please contact our broker support team at 1-888-54-Aetna (1-888-542-3862). Representatives are available Monday - Friday from 7:30 a.m. - 6:00 p.m. Central time.
Frequently asked questions
Q. My client said he/she just received a letter/call from someone asking if they would participate in an in-person health assessment. Is this something Aetna offers?
A. Yes, we are offering our members the chance to participate in an in-person health assessment.
We have contracted with MedXM and Your Home Advantage (depending on the member's location) to conduct the health assessments. The vendor will reach out to schedule appointments and answer any questions members may have. If members have any questions, they can contact the vendor directly at:
Med XM 1-888-306-0615
YHA 1-888-998-9880
This number will also be on the member's letter.
Q. Do members have to complete the assessment in their home? Can they go to another location?
A. In most cases, our vendors do not have a location in the member's area where he/she could go to complete the assessment. However, we usually find that our members prefer the convenience of completing the assessment in their own home.
If there is a local clinic available for members, their letter will let them know where they can schedule an on-site appointment.
Q. Can my client complete the health assessment online or over the phone instead of in person?
A. An in-person health assessment allows us to tailor the appointment to the member's needs and also answer questions they may have as they complete the assessment.
Q. My client was already asked to complete a health assessment over the phone. Is this the same thing?
A. No, the in-person health assessment we are offering our members is more detailed and will allow us to better identify members who might benefit from one of our care management or disease management programs. For this reason, our strategy going forward is to offer members the in-person health assessment. We will no longer conduct health assessments over the phone for our Individual and Small Group members.
Q. What will Aetna do with the data you collect from the health assessment?
A. The information we gather during the health assessment helps us gain a more complete picture of our members' health. With that information we can determine if they are eligible for any of our care management or wellness programs, which are part of members' benefits. We will also share information with the member's PCP, if he/she has one.
Q. How long will the health assessment take?
A. Typically the health assessment visit will take between 30 to 45 minutes.
Q. Is there a cost if my client decides to participate in the assessment?
A. No. This service is free for our Individual and Small Group members.
Q. Is there an incentive available for clients to complete the assessment?
A. We are not offering members an incentive to participate in these assessments.
Q. Are members required to take these health assessments? If they decide not to, will they lose their coverage or will their premiums go up?
A. While we strongly encourage our members to take advantage of this opportunity, because of the benefits it offers them, they are not required to participate in the health assessment. Their coverage and premiums are not impacted if they decide not to participate.
This is actually only a minor annoyance for me.
The non-continuation of NON GF policies is my biggest headache with them.
They are auto-enrolling clients into new 2015 plans that do NOT appear to be "comparable" coverage.
For instance:
$2500 deductible with $35/$50 CoPays. Paying about $650/month right now.
Auto-enrolling into a "Bronze Plan with $20 CoPays". Quoting them $550.
They don't tell them what their 2015 deductible will be.
They don't tell them that the 2015 PPO network will be MUCH smaller.
Client calls me saying that it sounds like a great deal.
No transparency allowed before November 5th, I guess?????
********************************************
Aetna Email dated Oct 23rd:
Client outreach for in-person health assessments
The Affordable Care Act is changing the way consumers engage in their health care. More and more consumers are entering the health care system. Many of these individuals have not had access to coverage for some time. They may not be aware of their current health needs or how their new plan can help them manage their care.
Recognizing this need, we continue to explore ways to engage to our Individual and Small Group members. Beginning this month, we will be reaching out to these members with an invitation to participate in an in-person health assessment. In most cases, the health assessment will be conducted in the member's home. In certain locations, members may also have the option to complete the in-person assessment at a local clinic, if there is a convenient location near them.
The information gathered through the health assessment will help us work with the member's primary care physician (if they have one) to coordinate their care and also identify if they are eligible for any of our care or disease management programs.
Outreach will begin this October and expand as we move through the rest of 2014 and into 2015.
Member outreach overview
Members will initially receive a letter from one of our vendor partners letting them know that this service is available and that we will be calling to answer questions and schedule an appointment with them. There is no cost to the member for this service for our Individual and Small Group members. While we strongly encourage members to take advantage of this opportunity, members are not required to participate in the health assessment.
As part of the health assessment, a licensed credentialed health care professional will review the member's current health status, medical history and current medications with them.
The information gathered in the health assessment will be used to gain a more complete picture of the member's health. We will also share the information with their PCP, if the member has one designated. This information can also help us identify if members are eligible for any of our care management or wellness programs.
Have questions? We're here to help.
You'll find some FAQs below that can help answer any questions you have. If you still have questions, please contact our broker support team at 1-888-54-Aetna (1-888-542-3862). Representatives are available Monday - Friday from 7:30 a.m. - 6:00 p.m. Central time.
Frequently asked questions
Q. My client said he/she just received a letter/call from someone asking if they would participate in an in-person health assessment. Is this something Aetna offers?
A. Yes, we are offering our members the chance to participate in an in-person health assessment.
We have contracted with MedXM and Your Home Advantage (depending on the member's location) to conduct the health assessments. The vendor will reach out to schedule appointments and answer any questions members may have. If members have any questions, they can contact the vendor directly at:
Med XM 1-888-306-0615
YHA 1-888-998-9880
This number will also be on the member's letter.
Q. Do members have to complete the assessment in their home? Can they go to another location?
A. In most cases, our vendors do not have a location in the member's area where he/she could go to complete the assessment. However, we usually find that our members prefer the convenience of completing the assessment in their own home.
If there is a local clinic available for members, their letter will let them know where they can schedule an on-site appointment.
Q. Can my client complete the health assessment online or over the phone instead of in person?
A. An in-person health assessment allows us to tailor the appointment to the member's needs and also answer questions they may have as they complete the assessment.
Q. My client was already asked to complete a health assessment over the phone. Is this the same thing?
A. No, the in-person health assessment we are offering our members is more detailed and will allow us to better identify members who might benefit from one of our care management or disease management programs. For this reason, our strategy going forward is to offer members the in-person health assessment. We will no longer conduct health assessments over the phone for our Individual and Small Group members.
Q. What will Aetna do with the data you collect from the health assessment?
A. The information we gather during the health assessment helps us gain a more complete picture of our members' health. With that information we can determine if they are eligible for any of our care management or wellness programs, which are part of members' benefits. We will also share information with the member's PCP, if he/she has one.
Q. How long will the health assessment take?
A. Typically the health assessment visit will take between 30 to 45 minutes.
Q. Is there a cost if my client decides to participate in the assessment?
A. No. This service is free for our Individual and Small Group members.
Q. Is there an incentive available for clients to complete the assessment?
A. We are not offering members an incentive to participate in these assessments.
Q. Are members required to take these health assessments? If they decide not to, will they lose their coverage or will their premiums go up?
A. While we strongly encourage our members to take advantage of this opportunity, because of the benefits it offers them, they are not required to participate in the health assessment. Their coverage and premiums are not impacted if they decide not to participate.
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- 8,448
After additional investigating, my suggestion is that your Aetna clients hide any valuable items before the 3rd World/Party vendor arrives at their home.
ac
ac
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