MA plans and CMS

Jan 4, 2007

  1. jacodaro
    Offline

    jacodaro Expert

    Posts:
    61
    Likes Received:
    0
    Wrote a bunch of these and CMS is dragging their feet on approvals. Some apps are pending for almost a month. These clients are unable to obtain their meds without CMS approval. They were instructed to use their enrollment form and a BIN # at the pharmacy but that does not work because without CMS approval they are not on any "list". Of course, I am being overloaded with calls from clients looking for their meds and I look like the bad guy. A pharmacy person told me this also happened last year. When was the last time the Feds got anything right? What a mess.
     
  2. midwestbroker
    Offline

    midwestbroker Guru

    Posts:
    2,371
    Likes Received:
    36
    State:
    Missouri
    CMS always drags its feet. If you have a pending app, you are in for a long haul.

    I had one pending last year for 2 months while CMS "researched it". After it was all done, they assigned him to the wrong company. Then we started the process all over again.

    Keep on the carrier to research it and push for an approval. They normally have people who can put a flame under CMS.
     
  3. maryjd123
    Offline

    maryjd123 Super Genius

    Posts:
    156
    Likes Received:
    0
    I had that happen alot last year with Humana --

    but this year I have stayed away from the ma plans with pdp -- the rates for the pdp plans doubled and tripled this year for humana -- thats why i switched to coventry -- advantra freedom and their rx plan as seperate entities... i have gotten 6 calls so far for people needing medications with no card... i called coventry -- no hold time whatsover -- the people i signed up on 12-31 --- were actually in the system on jan 1 -- i am so thankful and amazed -- all my customers can get their medications with no issues at all!!

    Also have you been telling them to get their generics at kmart or walmart? -- its cheaper than using the plan - 3.89 for generics... -- plus it will save their donut hole monies... I think the guy over at kmart likes me now -- i have sent him over about 50 new customers...

    you guys have a good one..

    mary
     
  4. midwestbroker
    Offline

    midwestbroker Guru

    Posts:
    2,371
    Likes Received:
    36
    State:
    Missouri
    My local Wal Mart has been really good about not charging the $4 generics against their Part D, so it does not go against the gap.

    Humana is the biggest player out here, but Coventry has the $0 premium MAPD plans. However, Coventry has a bad reputation with the Doctors out here for slow payment or no payment. I had a couple that was ready to sign with them, but I told them to call their Doctor, and he said he prefers Humana, better pay and claims process.

    One thing about Coventry they seem to be more local then others. I know that the KC office is focused on claims, plan benefits, sales, etc. The difference is that they seem to act like BCBS with separate identities.
     
  5. sman
    Offline

    sman Guru

    Posts:
    6,224
    Likes Received:
    233
    State:
    Georgia
    I wouldn't go singing the praises of Coventry just yet. I got a call yesterday from someone I signed up for Advantra Freedom 2 on 12/18/06. They don't have their cards yet, but they did get a bill in the mail for $98. Here in Georgia the AF2 has a zero premium. The AF1 has a $98 premium. So we did a conference call with Coventry. And guess what, they had them signed up for AF1. If you've seen the application, that should be impossible for someone to mistake AF1 for AF2. After having a discussion with customer service, she put us on hold to go speak to her supervisor about what needs to be done. She came back on the phone and stated,

    "O.K., here's what needs to be done. Mr. & Mrs. XXXX need to send in $98 each for January and they'll be switched back to AF2 in February"

    I politely told this young lady that there is no chance that my clients would pay $196 for Coventry's mistake and that I would like to speak to her supervisor. After another 5 minutes on hold, she came back and stated they would call me back.

    After all was said and done, they did get it fixed, but only after about 30-40 minutes of my time was wasted. I had another client that spent 30 minutes on hold on two separate occassions on Wednesday. It appears that they may be having the same problems Humana had. Too much, too fast.
     
    sman, Jan 5, 2007
    #5
  6. sman
    Offline

    sman Guru

    Posts:
    6,224
    Likes Received:
    233
    State:
    Georgia
    Midwest, the same complaints you're hearing about Coventry, I'm hearing about Humana here. I've had several tell me that doctors are putting signs up in their offices that they will no longer accept Humana GoldChoice. I even had a lady tell me her pharmacist will no longer accept them. And it's all the same response, "Poor customer service, low reimbursements and slow to pay".
     
    sman, Jan 5, 2007
    #6
  7. Crabcake Johnny
    Offline

    Crabcake Johnny Guru

    Posts:
    14,811
    Likes Received:
    12
    State:
    South Carolina
  8. maryjd123
    Offline

    maryjd123 Super Genius

    Posts:
    156
    Likes Received:
    0
    Yes you are right sman

    i think every plan is going to have their issues -- but as long as you are there as the agent and help everyone along -- its good
    more referrals :)

    have a great day everyone

    mary
     
  9. midwestbroker
    Offline

    midwestbroker Guru

    Posts:
    2,371
    Likes Received:
    36
    State:
    Missouri
    John - all that has been all over the Kansas City star. I have had only 2 people of the hundreds I have talked to bring up anything like that. News articles last about 5 hours, then people move on.

    Look at Firestone. I worked for them during the Ford recall. We were all over the news until the Florida voter mishap. Then Firestone went away, Florida was the next big thing until the next big boo-boo, and so on, and so on...

    But then again, a hospital's lawsuit against Coventry has been all over the paper as well. That was big news for a few days like mentioned above, and now it is a distant memory.

    Like it has been said before, every health insurance company has good and bad points. Mary has it right, an agent can make all the difference in the world.

    I have helped people successfully appeal claims they have had denied.

    It is like hospitals. Some love one, others would not take their enemies sick dog there.
     
  10. cod8825
    Offline

    cod8825 Expert

    Posts:
    30
    Likes Received:
    0
    Midwest you can take my enemies sick dog there
     
    cod8825, Jan 10, 2007
    #10
Loading...