Humana Gold Plus is calling their very recent disenrollees

[wehotex]

Maybe I never noticed this before?, but I just found out that one of my members was called by a Humana rep to persuade her to stay on with Humana instead of switching to UHC. The rep guilt-tripped her by telling her that she had been with Humana for such a long time, blah, blah, blah. Nothing really surprises me anymore, but I always thought that those kind of calls were supposed to happen AFTER the person was disenrolled?
I found out that Aetna is actively calling "my" members to try to persuade them to switch into a cheaper Aetna plan that is new to the area and also sending them postcards to do so. Only 1 of about 70 or so members has swallowed the bait, but phoned me to stay on the same plan that I put him on originally. Aetna is still leaving me as AOR when they do this, but last year I was not as lucky.
Is this new or they are just being more brazen about it?

 

[Real_AMG]

Is this new or they are just being more brazen about it?

Carriers soliciting your BoB isn’t new at all. Them leaving us as the AOR when they do is relatively new because they realized that screwing over their distribution had consequences.

You should report that rep to Humana though. Calling clients to verify that they chose to disenroll is fair game. Calling them to convince them not to disenroll is very clearly against CMS guidelines.

 

[policywunk]

The carriers can call after the disenrollment date to do a survey but not marketing.There are call centers agents who have intel on beneficaries and posing as being directly with UHC or Aetna.I had one the other who even knew my name as the AOR posing as UHC employed telesales-They definitely were not.

from cms guideline:

Call former enrollees after the disenrollment effective date to conduct
disenrollment surveys for quality improvement purposes.
Disenrollment surveys may be conducted telephonically or mailed.
Surveys conducted in either manner may not include sales or
marketing information.

 

[wehotex]

The carriers can call after the disenrollment date to do a survey but not marketing.There are call centers agents who have intel on beneficaries and posing as being directly with UHC or Aetna.I had one the other who even knew my name as the AOR posing as UHC employed telesales-They definitely were not.

from cms guideline:

Call former enrollees after the disenrollment effective date to conduct
disenrollment surveys for quality improvement purposes.
Disenrollment surveys may be conducted telephonically or mailed.
Surveys conducted in either manner may not include sales or
marketing information.

Call Centers (GoHealth as an example) KNOW that members are switching to another plan and can switch them? If they try to "re-enroll" the member, doesn't that just revert back to the original AOR?- seems like a waste of time to the telemarketer even if they have the ability to view recent disenrollees and "re-enroll" them.
I have one in my Humana Agent Portal that shows a DER date of 12-31-21, but then another entry for a 1-1-22 effective date both showing me as AOR. I'm guessing that the member might have responded to a commercial, disenrolled herself, but phoned Humana to get back on? I'll find out more from her.
Another Humana member told me that she received a lot of robocalls from Humana as well plus a member services rep who wanted to transfer her to Enrollment Dept to "re-enroll" her. The member cut her off and told her that she already disenrolled through the other company and would just wait until she receives a new Humana ID card. I'm going out (anyway) to re-write her just to make sure. Since this woman loves to talk, I'm sure that I'll get all the information that I want to hear.

 

[kstein]

The problem with this is you typically find out after the fact and aep is such a whirlwind that ive found it isn't worth tracking/chasing when so much new biz is lining up at the front door.

 

[policywunk]

Call Centers (GoHealth as an example) KNOW that members are switching to another plan and can switch them? If they try to "re-enroll" the member, doesn't that just revert back to the original AOR?- seems like a waste of time to the telemarketer even if they have the ability to view recent disenrollees and "re-enroll" them.
I have one in my Humana Agent Portal that shows a DER date of 12-31-21, but then another entry for a 1-1-22 effective date both showing me as AOR. I'm guessing that the member might have responded to a commercial, disenrolled herself, but phoned Humana to get back on? I'll find out more from her.
Another Humana member told me that she received a lot of robocalls from Humana as well plus a member services rep who wanted to transfer her to Enrollment Dept to "re-enroll" her. The member cut her off and told her that she already disenrolled through the other company and would just wait until she receives a new Humana ID card. I'm going out (anyway) to re-write her just to make sure. Since this woman loves to talk, I'm sure that I'll get all the information that I want to hear.

Humana /UHC can contact our members all they want and you still remain AOR.If gohealth switches my UHC SNP PPO to UHC SNP HMO for example I lose AOR.I think that some of these call centers agents have intel on beneficiaries from having access to the UHC /Humana captive /telesales agent telesales lead system maybe through a spouse or friend who is a captive agent.Of course many cold calling agents just say they are with UHC or Humana knowing that in some markets more than 50% of MA enrolled are with UHC or Humana-This happens often when there is a new upgraded version of an existing MA Plan in the market.This has been really bad in Florida where UHC DualComplete has come out with a new better DualComplete Plan .In some markets they have 70% of SNP Market so chances are high the cold caller claiming to be with UHC is reaching a UHC member

 

[DonP]

I’m in the field 6-7 days a week seeing 30-40 people a week . Even door knocked a lead last week and another agent was in their . Here are a few tricks going on . A few mentioned . Moving from hmo to ppo or ppo to hmo the easiest . Client says they love United or Humana . They simply switch them to another carrier for 1 month and then back and there the new Aor . That happens with phone reps doing a ton . Had a Referral woman call in Humana last week and she was transferred to a internal rep . He rolled her to a lis plan . Since she was 50% lis she had a $17 premium . She didn’t know that . I moved her to another plan . Without being in the ground I’m certain I wouldn’t have written 50% less business this aep . I was also selected to take live transfer leads with Humana . Out of 14 calls the last week I’ve only spoken too 2 people as other agents answering quicker . Human you call keep up with your book of business easy . United much tougher to track real time . The only way I’ve seen to do is pull up all your applications the past yr and if it’s cancelled it will say it . It’s a crazy dog eat dog jungle . If you don’t beat in your clients what’s going on your cooked . About 1/4 of my business this aep is referrals.

 

[yorkriver1]

Call Centers (GoHealth as an example) KNOW that members are switching to another plan and can switch them? If they try to "re-enroll" the member, doesn't that just revert back to the original AOR?- seems like a waste of time to the telemarketer even if they have the ability to view recent disenrollees and "re-enroll" them.
I have one in my Humana Agent Portal that shows a DER date of 12-31-21, but then another entry for a 1-1-22 effective date both showing me as AOR. I'm guessing that the member might have responded to a commercial, disenrolled herself, but phoned Humana to get back on? I'll find out more from her.
Another Humana member told me that she received a lot of robocalls from Humana as well plus a member services rep who wanted to transfer her to Enrollment Dept to "re-enroll" her. The member cut her off and told her that she already disenrolled through the other company and would just wait until she receives a new Humana ID card. I'm going out (anyway) to re-write her just to make sure. Since this woman loves to talk, I'm sure that I'll get all the information that I want to hear.

When they show that way on Humana it's usually because Humana cross walked the plan to another plan code, I have several now, double entries until they are transferred to the new version of their plan. This is not a sales situation, just a plan change, no people talking to the client.
It's when they show as ending, but no replacement also listed that they are leaving or have passed away, although Humana indicates that if it's the reason.

 

[wehotex]

When they show that way on Humana it's usually because Humana cross walked the plan to another plan code, I have several now, double entries until they are transferred to the new version of their plan. This is not a sales situation, just a plan change, no people talking to the client.
It's when they show as ending, but no replacement also listed that they are leaving or have passed away, although Humana indicates that if it's the reason.

That’s what I thought too. But the contract # and PBP are exactly the same.

 

[yorkriver1]

That’s what I thought too. But the contract # and PBP are exactly the same.

I am going to check with area mgmt. You are right, mine show the same plan ID's, but they are labeled as "plan transition" where the clients terming are not.