Humana Recertification

Jul 17, 2007

  1. sman
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    Has anyone completed the Humana recertification for PFFS plans? I just did it and it looks like there are really only a few changes.

    1 - There will now be an outbound call from the carrier to the client to make sure they understand the plan and they still want to enroll. (this is in addition to the inbound verification call).

    2 - There is now a leaflet that you must provide to the client which has some plan information on it and also includes info for Dr.'s offices so the client can give it to their doctor.

    3 - You have to make sure you inform them that they can see any doctor who is willing to accept the plans terms and conditions and that it is on a visit by visit basis. (I know we already do this, but the recertification course seemed to stress it over and over).

    That's it. I really didn't see anything different than what is already happening. Seems to me that all that was needed was for the carriers to implement an outbound verification system and print some leaflets.

    I talked with someone at Humana and they said they were shooting for an October 1 launch date for selling again. We'll see.
     
    sman, Jul 17, 2007
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  2. tommyk
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    I think the October 1st date is correct. I had heard today that Congress just passed a bill containing attached changes in the Medicare Advantage plans. The LCOEP is now ended. They needed the money for the child helath care.
     
    tommyk, Jul 17, 2007
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  3. policy doctor
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    I went last week for an INstill certification and they stressed similar conditions. In addition agent has a form that must be filled out with patients' doctors name, address, phone. t hey will all be contacted by the Instill call center.

    Sounds like everyone is tryng to eliminate confusion by providers about how these plans work by contacting them all PRE-NEED

    No more telephone enrollments.....must see client in person.

    Call verification by company to client will be from 1-10 days after receipt of app.

    (hey i just got a phone call from a stranger telling me there is a $3500 grant check from Federal gov't avail to me. All he needs to verify for transfer of funds is name, address, bank routing # [deposit within 2 hrs] . So i told him to hold because I work for FBI and my mgr is in.....would like to talk to him........CLICK]
     
  4. honestagent
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    R u serious?!??!!?
     
  5. Frank Stastny
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    I think all of these changes are very positive.

    Contacting their doctor is a good thing but it doesn't insure that doctors they may see in the future or if they are out of town will agree to bill the PFFS carrier. This is going to be an on going problem.

    Eliminating the telephone enrollments is going to create a hardship on agents who sell in multiple states. They are going to be punished for the sleazy ones who are only pushing the fact that they are "free". As always, it is the few that spoil it for the many. The carriers and agencies who have been ripping off agents have to be furious about this one.

    It sure took the new guys who think they can be underwear agents out of the mix. hahaha

    The call verification several days after the prospect signs the app is probably the best change they have made. That is the one that is going to hurt the "slamming agents" the most. It may force some of them to actually have to learn to sell.
     
  6. GreenSky
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    Telephone Enrollments

    I did not see that we are unable to enroll without seeing the client. My understanding is that there is a call at the point of sale (could be done by conference call I suspect) and then a follow-up call at a later date.

    If I must see each client, I'm out of the MA business. Many, if not most of my enrollments were with Pyramid and I entered the application on-line and did a verification by conference call.

    Humana isn't really a good choice for PFFS at this time as their benefits suck but we shall see what happens in 2008. I did the recertification already.

    Rick
     
    GreenSky, Jul 18, 2007
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  7. Frank Stastny
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    I knew you wouldn't like that part. It is going to hurt the "real" agents.

    I wonder if that is only Humana or if that is going to apply to all PFFS companies and sales?

    I have heard, just heard, not verified, that Humana was the main target of CMS and that was where the bulk of the problems were. Maybe this will just be a Humana thing.

    We can only hope it doesn't apply to Pyramid also.
     
  8. sman
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    I don't recall seeing anything in the Humana recertification that stated you had to make the sell face-to-face. Policy Doctor stated that about InStill.

    I'm with Rick. I did 95% of my MA enrollments on the phone and through the mail. If I have to see them face-to-face, it's going to be tough. Especially when there is only a 6-week period to enroll everyone.

    Only time will tell.
     
    sman, Jul 18, 2007
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  9. Frank Stastny
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    Frank Stastny Guru

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    I don't know anything about Humana nor do I intend to certify with them. I was just discussing what Policy Doctor said. He is a pretty savvy guy and if that is not correct then someone has given him "bad info".

    In the insurance industry do you think that is possible? :D
     
  10. senior-advisor-indiana
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    I need to certify for Humana's PDP. I should be getting the info by the end of the week.
     
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