ALERT Internal Issues with UHC

[policy doctor]

UHC is sending out some disenrollment letters to newly re-written clients whose current plan is being phased out by UHC.

I'm referring to exiting PPO plans which automatically transfer over to HMO unless agent writes a new app for an HMO or PFFS, but maybe the Evercare or SH is also affected.

Today 3 clients told me of receiving a letter informing them they were losing their Secure Horizons PLan 55 (which I had just enrolled them in 2 weeks ago) and that they would be put back into original Medicare unless they called this 1-866-579-8774 (which happens to be an UHC enrollment #) and then the happy CSR rewrites them while recording the whole event.

Obviously...the agent is screwed out of the picture.

Anyone else have this happen to them? People think this letter is originating from Medicare and they WILL call that Number and get re-enrolled. without you knowing!!

Not only is this underhanded and stealing from the agent....makes you wonder what else is being stolen... think identity theft.

 

[sman]

Why would you enroll them in SH 55 with a 20% OOP for outpatient surgery/services? Surely there is a better plan available in their area.

 

[policy doctor]

Not everyone likes an HMO.

 

[AttillaTheOne]

AND....Here in NW Florida, UHC has no HMO's, and terminated their PFFS plans. We have a pretty good PPO plan that beats Original Medicare. What else would you suggest for a senior who doesn't have the bucks to buy a supp? I am open to ideas.

 

[sman]

Not everyone likes an HMO.

I realize this, but are you saying that SH 55 is the best plan available in that area? It's only available in 12 counties in Georgia (for those of you in a state with few counties, Georgia has 159 counties so this plan isn't available in a large area although it does cover a large population). I'm here in Georgia and there are very few places where there isn't an alternative to SH 55, 51 or 1. As for HMO's, many are open access (no referral required) and some are actually POS plans which allow the insured to go outside of the network if they desire and pay a percentage (usually 20%). That makes it no worse than SH 55, but potentially a lot less expensive if they stay in network.

If you and the client can live with that potential exposure of 20% coinsurance, then have at it. I was a huge SH fan in 2009, but I replaced all of them for 2010. It only takes one $10,000 outpatient procedure for you to lose a client. I just have a tough time with this potential exposure. If I were you, I'd have the client sign something extra stating they understand their responsibility for outpatient procedures. Just some added protection for you.

Lastly, they better get used to an HMO/PPO if they are going to continue on a Medicare Advantage plan after next year. I hope you are preparing them for this.

 

[policy doctor]

Thank you for the fatherly counsel. I am not going to sign up with 5 or 6 diff companies for MA just so I can sell the "best" plan ...meaning what? Do you understand what OOP means? If they're not willing to buy insurance, they will have financial exposure somewhere. I lost my Sister Cleo turban so I can't predict what the year holds for them. Maybe the latest show On Coast to Coast can inform them.

Why, what are you selling? Aetna...Coventry..?..best one further west of you is neither of those.

 

[sman]

O.K. you can get your panties in a wad if you want. I'm simply pointing out some pitfalls in your "business model". I am certified with most every carrier that independents can sell. The reason? So I can do what is right for the client. That doesn't mean I sell with all of those carriers. This year it has been BCBS, CIGNA, Coventry, SecureHorizons (AARP HMO/POS plan) and Today's Options. I am certified with others but haven't sold any of them, but the list above is who I've sold with.

I don't try and fit a square peg into a round hole. It may work for you, but it doesn't for me. As for OOP, no I'm an *** why don't you explain it to me.

Look, if you're too lazy to get certified with multiple carriers then go right on offering one plan to all your clients. I bet you tell them you've reviewed all the plans and the SH's plan is what seems to fit their situation. Without regard to their medications or obvious health conditions. Do you even consider the fact that a senior is more likely to need Skilled Nursing benefits? SH 55 has charges from day 1 and last until day 26. Sure they have a maximum out of pocket on the plan, but why should we make sure they get there the quickest way by offering an inferior plan? Oh yeah I forgot, because you don't want to certify with more than one carrier. Do you run a comparison on their meds and see if SH is competitive? Do you make sure all their meds are on the formulary? If you do make these checks, what happens when SH is much more expensive then other carriers or a med isn't on their formulary, but is on another carrier's? Do you let them know they could pay less elsewhere?

Like I said, if you can sleep at night, then more power to you. I make a recommendation only after reviewing my clients situation. This means I get a list of their meds, run a comparison and even put together a spreadsheet for my benefit to make sure I've looked at the plans available to them. I also get a list of the doctors they use to make sure they are in the network of any HMO/PPO plan.

I guess you'll have to change your tune a little if you plan on offering MA plans for 2011. But for now, you can be a one trick pony. Regardless of how it may impact your client.

Thank you for the fatherly counsel. I am not going to sign up with 5 or 6 diff companies for MA just so I can sell the "best" plan ...meaning what? Do you understand what OOP means? If they're not willing to buy insurance, they will have financial exposure somewhere. I lost my Sister Cleo turban so I can't predict what the year holds for them. Maybe the latest show On Coast to Coast can inform them.

Why, what are you selling? Aetna...Coventry..?..best one further west of you is neither of those.

 

[policy doctor]

For my edification, please name the medical procedure that would cost $10,000 outpatient?

Another question...I started this thread curious to see if other agents were being contacted by clients about faulty disenrollment. Somehow you managed to twist this into a critique of product choices.

Are you able to focus, or trolling for an argument?

 

[dandan]

Ok, What is right for the client hmmm Medicare Supplement!

 

[captain94]

For my edification, please name the medical procedure that would cost $10,000 outpatient?

Chemo and Radiation for cancer are both outpatient Charges.

I had a client get a letter from UHC and he called them directly and changed plans. They gave me the credit for the new plan. I called the PHD and they said there policy was if a client calls directly the writing agent will always get credit. If a new agent goes out and switches them the "New Agent" would get that client.