Carriers running AEP from the Philippines

[somarco]

Ran a drug report for a client earlier. Her current plan was "charging" too much for bimatopost (generic Lumigan)

According to Mcare.gov Aetna Rx Saver (current carrier) shows a copay of $129. The drug is non-formulary so that is also the "retail" price.

Cigna Healthspring Rx Secure copay is $15. Their "retail" is $69.

Hmmmmm

Rx Saver premium is $23; Cigna is $59. Even paying the higher premium she cuts her copay from $129 to $15.

This woman double checks everything.

So she called Cigna.

The woman who answered the phone had a thick accent.

Where are you?

Unresponsive.

Where are you located?

Finally she said the Philippines.

Things went off the rail from there.

Filipino woman said bimatopost is not on the formulary and my clients monthly copay would be $2,000!

(When my client told me the story I said she must have been quoted Filipino peso's where 2,000 peso's = $37.)

Now we have monthly copay's ranging from $15 to $2,000 and retail pricing from $69 to $129.

GoodRx has it for $45.

Is it any wonder no one can figure out how Part D works.

Have to admit, hiring folks in the Philippines to give Part D advice and take orders is a bit unsettling.

 

[Northeast Agent]

Sounds shady and illegal to have a carrier giving Part D advice from outside of the US. Obviously not licensed agents, either.

I'm working (very) part time at a call center this AEP. Logn story, but it's where I got started/licensed a few years back. They are short agents and I need some extra weekly cash flow. The program I'm on is for a regional carrier in five states. How it works is a beneficiary calls an 800 number and gets customer service, who transfers them to a "screener" in the Philippines. They are supposed to weed out the duds, such as Under 65 business, those without a SEP, etc. It was busy a few years ago, but due to screeners it's very slow.

By the time they reach a licensed agent, they are hopping mad. A lot of the Filippinios are hard to understand. We have to ask the beneficiary again to confirm their name, Medicare number, address, etc. And if they want to enroll, we transfer them to ANOTHER call center, this time in the States. But they aren't helping with Part D, just screening and the carrier claims it saves money. Doesn't matter that people are mad.

So they purchased the five non-resident health licenses for me. Some of them are pretty expensive. And an *** in the licensing department there dropped the ball and put me on another program by mistake originally, so they bought me six MORE licenses that were unnecessary. Since I'm tired of just calling my home state and the state across the bridge, I'm going to start calling some other states starting Monday that look sweet for Med Supp sales and take advantage of my windfall.

 

[somarco]

They are short agents

Filipino's generally are . . .

Sorry. Couldn't resist.

As for the carrier advising folks from the Philippines, nothing really surprises me any more. Carriers can do almost anything they want with impunity.

 

[Northeast Agent]

True, haha.

And yes, the carriers do seem to get away with a lot.

 

[sshafran]

There is a sense in which we can't really worry too much about whether Medicare.gov is giving accurate pricing. We have too many people to talk to, too many Rx's to look up, etc.

Each client I talk to, I tell them "Medicare is estimating x as your lowest overall yearly cost option. This factors everything: The Premium, Deductible if applicable, and the Copays on the Medicines that you told me at the preferred pharmacy that you told me to put in." It's quite literally the words that have been programed to come out of my mouth.

I normally will save the .pdf of the "illustration" as Last Name_ First Name - 2019 - Your Medicare Health Plan Details and attach it to the CRM (and often e-mail it to them).

I know you probably do the same thing. I think I'd start to feel a little agitated if a client / prospect wanted me to go beyond Medicare.gov directly to each carrier's site to verify.

Not only do I not want to, but more importantly, I really don't want to

 

[LostDollar]

Filipino woman said bimatopost is not on the formulary and my clients monthly copay would be $2,000!

Would this be "The Case of the Missing R"?

bimatoprost

 

[somarco]

I don't have the time nor will I make the time to check against the carrier site. I run the reports, save and send the side x side comparison plus the monthly cost (copay) report with their name and year. Also save each yrs drug list.

I send our a narrative which takes some time.



Keep your current plan and fill at Kroger your premium is $X and your copay's are in the attached report.

Change to XXX your premium is $Y and your copay's are in the report.

You could save money by changing carriers and pharmacy's. Before you change anything verify the copay's against the Medicare report.



Sometimes I will have a client want to argue that the copays for their current plan aren't right. I don't have time or desire to debate. Just tell them if they can get the quoted copay's in writing keep what you have.

I do go past Mcare.gov and spot check prices vs GoodRx and BlueSky (Canadian pharm). That's it which is more than most agents do.

 

[sshafran]

Would this be "The Case of the Missing R"?

bimatoprost

What would we do without you??

 

[somarco]

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