PFFS Plans - STOP SELLING!

[midwestbroker]

Sounds like there are 2 issues here:

1. Agents promising the world, or mis-informing the clients

2. Providers unaware of PFFS plans and not taking them

In regards to the second, this will only hurt the process, unless they start communicating with doctor offices. Some still do not know what a PFFS plan is. Others have only looked at one, decided they did not like the plan, and said no to them all.

Now, in the consumer eye, this all depends on the press. If they run with it, that could hurt the PFFS sales. If they do not, most people will have no idea what is going on.

 

[senior-advisor-indiana]

I hope that journalist from Ft wayne, IN write another story..

 

[GreenSky]

I would not be surprised if plans start selling through captive agents only.

I've run into people all over the country that were cheated by agents. Many did not know they even signed for a plan.

Agents would do the equivalent of "Wham, bam, thank you ma'am" as respects the PFFS plan. Many had no idea of what had even happened.

If we can't police our own, the government will feel compelled to do it for us.

Rick

 

[GreenSky]

It's a damn good thing we can sell that zero premium life insurance policy. That will more than make up the loss of income from the PFFS plan moratorium.

Rick

 

[senior-advisor-indiana]

Actually, I have ran into clients who had captive agents from senior solutions sign them up without knowing...... I think its funny that they won't have any products to sell now. Atleast here in IN.

 

[midwestbroker]

The problem with using captive agents is that they cannot survive in the rural markets.

In metro areas, I know that Humana only has captive agents sell the HMO and PPO plans. Coventry does the same here in Kansas City.

Both, however, use brokers in the rural markets.

It seems that this is more of a provider contracting issue, since the sale of HMO and PPO polices are not effected.

 

[Frank Stastny]

Personally I have never liked them from the beginning. I have not moved any of my existing clients into them and strongly recommend to prospects that they take a Med Supp instead. I work the rural areas and occasionally in St. Louis.

I got a call yesterday from a woman in St. Louis, a referral, who is turning 65 and she asked about them. She thought that is what she wanted. Wrong! I ended up selling her a Med Supp. Yep, I did it over the phone but not in my underwear, a ratty pair of Levis and a "Testicle Festival" t-shirt. LOL

Maybe when my clients, and the prospects who have asked me about them, see the news it will add a little more credibility to what I told them. I only have three clients who have PFFS, the rest are on Med Supps. The three who do have them couldn't get a Med Supp.

Like Senior, I will be contacting those prospects who I know took a PFFS plan and again suggesting they may want to consider a Med Supp.

Senior, we are going to get rich. Thank you for screwing things up CMS.

 

[senior-advisor-indiana]

Also another good reason to have YIO. I unlike Frank have to round up all the leads of people I talked to that have PFFS plans. What a bummer.

 

[honestagent]

While dismayed and extremely disappointed, I am not completely shocked. Thank you everyone for posting. It's actually a week from today we can no longer do any more bz. on the PFFS side.I received emails from Humana, Coventry, and Pyramid today. Funny though, I learned the news from you good people here and not my FMOs. Thank you.

Nothing yet from United or Wellcare but I'm sure that's just a matter of time. These plans are NOT for everybody and far toooooooooooo many agents have abused this. I truly feel they have a place for some; but not for all. You get what you pay for; so if one can afford the med sup, do it. that's my personal stance. Midwest called it right on with the providers not being fully informed. That's also a huge part of this mess too but I know all of you are aware of that.

I have posted what Pyramid says below and their last day to do business.

From this post, it says - no more bz. till fall for 08 effective date.

My question is do you guys and gals think they will change their minds to allow us to sell this year 07 for 07 or it's a full hecky no?


http://image.exct.net/members/22799/1 CMS.TO.Suspension.FINAL.pdf



URGENT AGENT FIELD BULLETIN
Monday, June 18, 2007​

TODAY'S OPTIONS SALES TEMPORARILY SUSPENDED,
EFFECTIVE FRIDAY, JUNE 22, 2007 ​

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On Friday, June 15th, Universal American, along with six other PFFS plan sponsors, coordinated with the Centers for Medicare and Medicaid (CMS) to temporarily suspend the marketing of PFFS in the individual, non-group market until we demonstrate our compliance with CMS's new 2008 marketing requirements. The temporary suspension is effective on Friday, June 22, 2007.
Nothing is more important to us than the relationship we have with our members. We are, therefore, in full support of the effort by CMS to help the industry improve the way in which it markets this valuable coverage to Medicare beneficiaries. We are proud of the rigorous marketing and sales approach we've employed to date, yet we stand ready to review and change our marketing practices in whatever way necessary to meet the new standards.
This suspension of marketing activities of Today's Options is temporary, and will be lifted after CMS reviews and approves our marketing material, agent training materials and tests, systems and controls that will enable us to satisfy their new 2008 marketing requirements. Because we already perform many of these 2008 requirements today, we believe we are in a position to satisfy CMS in a relatively short time. Therefore, we are confident that we will be able to have you resume your marketing of Today's Options within a brief period of time after the CMS review process concludes.​

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READ CAREFULLY – IMPACT TO AGENTS AND BROKERS​

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If you are a current certified agent or broker of Today's Options, you may continue selling Today's Options in accordance with CMS's marketing guidelines and our corporate policies until close of business on Friday, June 22, 2007. After that date, YOU MAY NOT engage in any marketing activities regarding Today's Options whatsoever. Any application submitted by an agent or broker and received after the close of business on this date WILL BE REJECTED.
For the avoidance of doubt, you may not advertise Today's Options, send out lead cards, set appointments (even if requested to do so by a beneficiary), contact prospective customers, conduct seminars, or do any other kind of marketing or sales activities.​

Continued​

After CMS has completed its review of our enhanced marketing and sales procedures, systems and controls, all agents or brokers must also complete a training course and pass a written test that demonstrates their thorough familiarity with both the Medicare program and our Today's Options​

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Suite 5001
Lake Mary, FL 32746
www.todaysoptions.com
www.pyramidlife.com www.amerprog.com​

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plans. Upon passing the test, an agent will be "re-certified" to sell the product. The training program and additional communications will provide instruction on all new procedures and practices that affect agents and brokers and are derived from the new CMS requirements.​

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OUR GOALS REMAIN THE SAME​

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While our policies and procedures will change slightly as a result of this announcement, our overall goal remains the same: to ensure that we set a leadership standard not only for CMS compliance but, more significantly, to meet the expectations of our customers and to deliver high-quality benefits and service to Medicare beneficiaries.
Please take a moment to review the attached press release issued late this afternoon by American's Health Insurance Plans (AHIP). AHIP played a central role in helping to align CMS and the insurance industry on this initiative, and we are proud to have provided added leadership and support as a member of the association. The press release issued by Universal American is also attached for your review.
We apologize for the interruption of your business activities, but we believe that this important initiative will, in the end, serve the best interests of your clients. We are working diligently to enhance our systems and controls to ensure that we get through this process as quickly as possible, and we will continue to update you as we know more. In the meantime, we ask for your patience as we fight the battle to end the improper sales tactics that have caused this suspension. We thank you in advance for your support of this important initiative.
Very truly yours,
Gary W. Bryant
President, Pyramid Life Insurance Company
Executive Vice President, American Progressive Life & Health Insurance Company​

of New York
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[policy doctor]

I thought about this last night

and I think the real problems here are the medical providers/billing depts.

They are KEY to making this transistion from Orig Medicare to an Advantage company. If that claim is not processed properly by them, then you have unhappy customers all the way around....Dr.,patient, biller,CMS...carriers.

Factor in that providers can drop participation anytime because there is no "formal" contract, and this becomes too fluid and unstable. When this took off in 2006, I think a PPO/HMO model should have been used to start with initially. It would have given everyone time to assimilate a new alternative to healthcare for seniors. Carriers would have had time to solicit the medical community to participate.

Instead, these MA's came out like a "IN YOUR FACE" blitzkrieg. "Dr, if you don't take these co-pays, you better not treat the patient or you will be forced to do so".

I and others have posted some articles that were negative press about the MA's. Well let's see how this plays out..but stay in touch with your Advantage clients. You may have to become an "Oral Roberts" and "convert" them to the other side. LOLOL