Humana Recertification

[sman]

I need to certify for Humana's PDP. I should be getting the info by the end of the week.

The rules for PDP may very well be different than MA-PD PFFS plans. I suspect they are seeing that they suspended PFFS enrollments and not PDP enrollments. I say that to say, you will likely be able to enroll people over the phone for the PDP plans. And let's just hope that we can continue with the PFFS plans whether it's Humana, Pyramid or any other carrier.

Attached is a copy of the Humana Recertification Manual.

 

[Frank Stastny]

The rules for PDP may very well be different than MA-PD PFFS plans. I suspect they are seeing that they suspended PFFS enrollments and not PDP enrollments. I say that to say, you will likely be able to enroll people over the phone for the PDP plans. And let's just hope that we can continue with the PFFS plans whether it's Humana, Pyramid or any other carrier.

Attached is a copy of the Humana Recertification Manual.

I enrolled a client in a PDP plan six days ago so I know that nothing has changed so far.

 

[sman]

I enrolled a client in a PDP plan six days ago so I know that nothing has changed so far.

I was speaking of rules for 2008 and whether or not we will be able to enroll over the phone or on the internet instead of face to face as someone suggested earlier. I guess I wasn't very clear.

 

[policy doctor]

Well guys....Aetna is moving into this arena and i will attend their class coming up. I will ask those same questions. Esp about enrolling thru the mail/phone. I sold some that way too.

Better yet, I will contact the mgr who invited me. ( Prior acquaintance.)

Hope to have more answers by next post.

 

[sman]

Well guys....Aetna is moving into this arena and i will attend their class coming up. I will ask those same questions. Esp about enrolling thru the mail/phone. I sold some that way too.

Better yet, I will contact the mgr who invited me. ( Prior acquaintance.)

Hope to have more answers by next post.

Policy Doctor, you're in Georgia right? Who are you using for Aetna? I've yet to contract with them. They only have an HMO and so I didn't fool with them this year.

 

[policy doctor]

Sman:

This would be a direct contract so don't sign up with anyone yet.

I don't think this is an HMO...i can pm you if you want to come to the mtg. Next week.

 

[sman]

This would be a direct contract so don't sign up with anyone yet.

I don't think this is an HMO...i can pm you if you want to come to the mtg. Next week.

Send me a pm with some details.

 

[Cenla Agent]

Unless something has changed, you can be certified for PDP only with Humana without being MA certified. They are no doubt still a good plan to have but in my state at least they are no longer head and shoulders above the other companies for Part D as was the case in 2006. Their premium is still a good deal lower in most cases but depending on what meds the member is on, another plan like United or Blue Cross may be better overall since their copays are often lower.

 

[Cenla Agent]

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.

As someone said, Humana's PFFS was not competitive in most areas for 2007. I agree. Their plan B PFFS was fairly competitive WRT to benefits but not price in many areas.

All of the horror stories I heard with agents misrepresenting plans, supposedly enrolling people without their consent, etc. involved either Pyramid or Aetna agents. But of course that's just anecdotal evidence. Regardless, one only need look at the Any, Any Any saga to see that this certainly isn't "just a Humana thing." If it was just a Humana thing then why were the other companies involved with the moratorium as well? I do know with Humana that a verification call is mandatory and that you will lose your appointment or job if it is not done. I think that is supposed to be the case with Pyramid as well. My understanding from reading the moratorium announcement is that all carriers will have to start doing verification.

In 2006 when I was captive with Humana the verification team was only there certain hours, if they weren't in you marked the app for outbound verification. (Marking it for mail out verification unless it was a PDP app was grounds for dismissal IIRC.) This year they used an automated (IVR) system that was supposed to be available at all times if you were doing a paper app, and the only time they weren't available for me was on a Sunday afternoon.

 

[Frank Stastny]

All of the horror stories I heard with agents misrepresenting plans, supposedly enrolling people without their consent, etc. involved either Pyramid or Aetna agents. But of course that's just anecdotal evidence. Regardless, one only need look at the Any, Any Any saga to see that this certainly isn't "just a Humana thing." quote]

I'm sure you are right. I should know better than to repeat something that I "heard".

There is no doubt in my mind that all the companies probably contributed to all the problems.

Thanks for the info.