My MA customer doesn't trust me anymore

[wehotex]

So, I've had these Medicare Advantage customers (husb and wife) for about 10 years now. They've always owned properties and had $$. I had discussed other options like PPO and Med Supp in the past with them since I knew that they could afford it. But, they always stuck with the HMO that I originally sold them because they liked $0 premium and low copays. Their daughter phoned me a couple of months ago to demand "Why I sold them THAT insurance?!!" I told her that is what her parents wanted and it had worked well for many years- until now. Apparently, the mother now required a partial corneal transplant which was actually approved by the HMO, but they were unable to find a facility to operate in. The dtr told me that the facilities did not want to do it because it "did not pay enough". The ophthalmologist's office was not helpful in this situation. The members were told that a PPO would work in this situation. Since the members were well off and had no chronic conditions and SEP-qualified, I asked the daughter to phone into 800-Medicare and ask for an exception SEP. I guess that she never received it. Since I took a full time job, it's been hard for me to respond to these situations. Needless to say, I would have 3-way called with 800-Medicare and customer to plead for the SEP. Alas, I have very little time to do that anymore. Anyhow, it looks like the members enrolled into Aetna PPO for a Jan 1 effective date. I feel guilty that I couldn't help them cause they are a really nice couple. The dtr was really angry with me and made me feel like a crook.
For those of you who sell Med Supp, would there have been ANY med sup product that would have accepted this woman in her situation, albeit at a very high premium? I'm even wondering if the PPO will work for this situation? I want to prepare for this kind of situation in case it happens again and I feel pretty shitty about the whole thing.

 

[somarco]

Isn't it interesting the way folks LOVE saving money until they realize the party is over and they may have to pay out of pocket if they don't follow the rules?

And no, they can't qualify for a supplement plan for the same reason they can't buy a HO policy once their house is on fire.

Rather than calling for an SEP or trying to the facility or MA to change their mind and make an exception, why not get a list of approved providers for this particular situation and tell your former client pick from this list and this list only?

(Paraphrasing from Private Benjamin), this isn't the Army with the yachts and condo's. Play by the HMO rules if you want your claims paid. You don't get to make up your own rules to suit you.

 

[axeman462]

Customers gotta blame someone, why not the agent? *Sarcasm*

 

[somarco]

Customers gotta blame someone, why not the agent? *Sarcasm*

And when they do it direct without an agent they still want to blame someone else

 

[axeman462]

And when they do it direct without an agent they still want to blame someone else

lol aint that the truth!

 

[sshafran]

So, I've had these Medicare Advantage customers (husb and wife) for about 10 years now. They've always owned properties and had $$. I had discussed other options like PPO and Med Supp in the past with them since I knew that they could afford it. But, they always stuck with the HMO that I originally sold them because they liked $0 premium and low copays. Their daughter phoned me a couple of months ago to demand "Why I sold them THAT insurance?!!" I told her that is what her parents wanted and it had worked well for many years- until now. Apparently, the mother now required a partial corneal transplant which was actually approved by the HMO, but they were unable to find a facility to operate in. The dtr told me that the facilities did not want to do it because it "did not pay enough". The ophthalmologist's office was not helpful in this situation. The members were told that a PPO would work in this situation. Since the members were well off and had no chronic conditions and SEP-qualified, I asked the daughter to phone into 800-Medicare and ask for an exception SEP. I guess that she never received it. Since I took a full time job, it's been hard for me to respond to these situations. Needless to say, I would have 3-way called with 800-Medicare and customer to plead for the SEP. Alas, I have very little time to do that anymore. Anyhow, it looks like the members enrolled into Aetna PPO for a Jan 1 effective date. I feel guilty that I couldn't help them cause they are a really nice couple. The dtr was really angry with me and made me feel like a crook.
For those of you who sell Med Supp, would there have been ANY med sup product that would have accepted this woman in her situation, albeit at a very high premium? I'm even wondering if the PPO will work for this situation? I want to prepare for this kind of situation in case it happens again and I feel pretty shitty about the whole thing.

5) Do not feel guilty, as you did them a good job, you saved them a ton of money...only thing I would have done different is check the directories, call member services, to find them an in-network provider.

As bmarsh basically said, you need to have a little bit of "I don't care" in this business.

And I'm not joking or anything - you really need to not care at times.

My perspective is this: I tell people about insurance options, and they buy (and yes, a $0 premium mapd plan is "bought."). I know some of them won't like what they bought later. Too bad for them - they are adults - I explained their options, they've made it more than 60 years on planet earth, and I'm not their babysitter. I have books to read and kids to take to the beach, life is too short to worry about their decisions.

If things start to go sideways with the plan they picked... I focus on what I can do (help them shop options with a "fresh perspective") - not what they decided in the past - even if I sold it to them.

36 minutes ago I received a slightly "angry" e-mail from a client who has a Plan F Med Supp + PDP, but he's complaining about the donut hole, again, as if I have a magic wand to make it go away. I've exchanged.... 5-6 e-mails over the course of the past few months with this individual and I really don't care to hear his complaints any longer.

This particular e-mail was, basically, that he had "better know exactly what he'll be paying next year when he hits the "freaking donut hole." (his actual words)

So... we'll review his PDP, project his donut hole costs, and I'll send him a printout, then I'll grab a good book and forget he exists, until his next e-mail when he complains about somethings, which I'll professionally respond to, then move on, again.

In short - respond professionally, but don't ever feel "guilty."

 

[Chazm]

As bmarsh basically said, you need to have a little bit of "I don't care" in this business.

And I'm not joking or anything - you really need to not care at times.

My perspective is this: I tell people about insurance options, and they buy (and yes, a $0 premium mapd plan is "bought."). I know some of them won't like what they bought later. Too bad for them - they are adults - I explained their options, they've made it more than 60 years on planet earth, and I'm not their babysitter. I have books to read and kids to take to the beach, life is too short to worry about their decisions.

If things start to go sideways with the plan they picked... I focus on what I can do (help them shop options with a "fresh perspective") - not what they decided in the past - even if I sold it to them.

36 minutes ago I received a slightly "angry" e-mail from a client who has a Plan F Med Supp + PDP, but he's complaining about the donut hole, again, as if I have a magic wand to make it go away. I've exchanged.... 5-6 e-mails over the course of the past few months with this individual and I really don't care to hear his complaints any longer.

This particular e-mail was, basically, that he had "better know exactly what he'll be paying next year when he hits the "freaking donut hole." (his actual words)

So... we'll review his PDP, project his donut hole costs, and I'll send him a printout, then I'll grab a good book and forget he exists, until his next e-mail when he complains about somethings, which I'll professionally respond to, then move on, again.

In short - respond professionally, but don't ever feel "guilty."

Exactly. And I make sure to tell clients I don’t recommend rx plans. I simply enter in their medications to Medicare.gov and that site will tell me where they estimate they will spend the least amount of money next year if their drugs stay exactly the same.

Too many clients call each year and say, “you recommended this plan would be the best for me”. Whoa whoa lady, I never said those words.

 

[somarco]

I still don't see why @wehotex is trying to change something that has worked for 10 years. If he does get it changed to their (current) satisfaction what's to say they won't come back during the next crisis (and there WILL be one) expecting him to work miracles again?

 

[rousemark]

The dtr was really angry with me and made me feel like a crook.

Then, that is your fault.. A person can only make you feel like something you aren't if you let them...

 

[hockeyday]

So, I've had these Medicare Advantage customers (husb and wife) for about 10 years now. They've always owned properties and had $$. I had discussed other options like PPO and Med Supp in the past with them since I knew that they could afford it. But, they always stuck with the HMO that I originally sold them because they liked $0 premium and low copays. Their daughter phoned me a couple of months ago to demand "Why I sold them THAT insurance?!!" I told her that is what her parents wanted and it had worked well for many years- until now. Apparently, the mother now required a partial corneal transplant which was actually approved by the HMO, but they were unable to find a facility to operate in. The dtr told me that the facilities did not want to do it because it "did not pay enough". The ophthalmologist's office was not helpful in this situation. The members were told that a PPO would work in this situation. Since the members were well off and had no chronic conditions and SEP-qualified, I asked the daughter to phone into 800-Medicare and ask for an exception SEP. I guess that she never received it. Since I took a full time job, it's been hard for me to respond to these situations. Needless to say, I would have 3-way called with 800-Medicare and customer to plead for the SEP. Alas, I have very little time to do that anymore. Anyhow, it looks like the members enrolled into Aetna PPO for a Jan 1 effective date. I feel guilty that I couldn't help them cause they are a really nice couple. The dtr was really angry with me and made me feel like a crook.
For those of you who sell Med Supp, would there have been ANY med sup product that would have accepted this woman in her situation, albeit at a very high premium? I'm even wondering if the PPO will work for this situation? I want to prepare for this kind of situation in case it happens again and I feel pretty shitty about the whole thing.

What State you in Michigan has 2 guarantee issue companies