PFFS Plans - STOP SELLING!

[policy doctor]

Well this sucks too.

Got another reminder about the suspension of PFFS sales from Todays Options. In the letter, American Progressive addressed the leads situation for those who had ordered thru their lead house (lead mgmnt systems) .Well if it was too late to stop the processing( Leads mailed out already) but the leads had not come back yet. So their brilliant solution is to HOLD those leads until such time as suspension is lifted.......like in Oct-Nov I think?

So here you are, and Indy agent who bought their mailers, hoping on a decent return(poor hope) to sell a product (now defunct) and being informed your responses will age like limburger cheese while Nero fiddles.

Why the heck can't they just pass on the leads to you, so you can contact folks and sell med supps in the interim....or at least stay in touch. If you paid, don't you OWN? Another nail in the coffin of health insurance.

 

[honestagent]

FYI: If you plan to write Wellcare this week, you must submit bz by 5:00pm est 6/21/07 or no $$$$ and no enrollee processed. $$$$, what's that?!?!?


United, Coventry, and Pyramid is 6/22 - Friday.



One email I received said the suspension would last as little as 4 weeks assuming the companies integrate the added 'policing' what CMS is asking but nobody knows for sure. Hey here's an idea.... can we get those docs' billing specialists and broker support people certified too?!??! (notice I did not say re-certified). It's ONE FORM THEY NEED TO LEARN... ONE... from what I've been told time and time again.

Heck, they make us jump through these hoops and as far as I'm concerned, doctors' offices - specifically are key ball players in this game! Talk about a debacle... and the reality here folks is that it's just going to perpetually get worse; more intervention by CMS is not the answer. Hell, it's not even a decent bandaid to the sore but at least the wound is somewhat covered momentarily.


As for HMOs, somebody mentioned utilizing the books, proceed with extreme caution when showing those; many of those PCPs in those books may not be updated or taking new patients so you could be in for a very rude can opening of spoiled worms.

Those directories, can at times, be used as a tool of 'selling' or advertisement, IE: "Mr. Client, look, we have over 800 doctors in our network and our book and network is constantly being updated; here's your copy for you to select from." Geeeeeee.... and out of the book, only 20 some take new patients. Do you as an agent know which 20 are presently taking new patients; and further, each month the panel could close and then later re-open and then close then re-open and I think you get the gist and if you don't here's the bottom line: LOTS OF PRE-AND POST SERVICE work for you - the agent - assuming you want to do it all right, which I know some of you do. And that's one facet of HMO service work; I have not enumerated other parts of this.

I cannot comment on the PPOs because I've never sold them. Anybody care to ellaborate?

So do you still want to do Medicare..... hee hee lol...

 

[honestagent]

Here's a different spin from another source: Can somebody please deduce the 4th bullet; I'm having difficulty understanding why an agent will not be paid????

[FONT=Verdana,Geneva,Arial,Helvetica,sans-serif][FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]Carriers Temporarily Suspend PFFS Marketing
June 18, 2007 [/FONT][/FONT][FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]The Centers for Medicare and Medicaid Services (CMS) announced that in response to concerns about marketing practices, seven health care sponsors have signed an agreement to suspend voluntarily the marketing of Private-Fee-For-Service (PFFS) plans.
This suspension for a given plan will be lifted only when CMS certifies that the plan has the systems and management controls in place to meet all of the conditions specified in by CMS. The carriers include: United Healthcare, Coventry, Humana, Wellcare, Universal American Financial Corporation (Pyramid), Sterling, and Blue Cross/Blue Shield of Tennessee. Small Cost Plans, PPO and HMO sales will continue. Part D sales are not affected.

[/FONT]

• [FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]Indications that we are getting seem that this suspension could last as little as 3-4 weeks, provided the companies complete the requirements that CMS has put forth. [/FONT]
• [FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]Each company may go back into sales at a different time, depending on when each company gets its new tests, ads etc sent to CMS and approved. [/FONT]
• [FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]You will have to RE TEST to continue to sell in 2007 for each company you represent. The tests should be harder as CMS attempts to "weed out" the agents who are creating these problems and do not truly understand this product.[/FONT]
• [FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]All companies will begin to make outbound verification calls to all new applications to insure that they understand the product at time of sale. This is a change that benefits us all.[/FONT]
• [FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]Clients can continue to go online, call the company directly and mail in applications now--but agents cannot be involved or be paid! [/FONT]
• [FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]Clients turning 65 in August & September: call them this week. Your applications must be received by this Friday to be processed. Late apps should be rejected (but we are not really sure who they will be handled).[/FONT]

[FONT=Verdana,Geneva,Arial,Helvetica,sans-serif][/FONT]
[FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]We also feel that this action will put us in a much better position to be able to market PFFS plans to client for next years Annual Election Period (AEP), due to the corrective nature of this action against some of the bad press that has recently been out concerning PFFS plans.[/FONT]
[FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]Please keep in mind that this does not affect your ability to write Medicare HMO, PPO, or POS plans (United Health Care Medicare Direct, Evercare PPO). We will continue to keep you abreast of information on this situation as it develops.
[/FONT]

 

[Bob_The_Insurance_Guy]

I hate to admit it, but the Evil Empire's product, combined with a PDP, is looking pretty good now.

Blue Cross has a HMO and a PPO product. I'm going to sell that, now, with the Coventry PDP, which has an extensive formulary (Advantra Rx)

Around here, its either BCBS's or Worlds Med Supps.

 

[kingedgars]

Nov. 15th was the date I was told

Yesterday, Coventry told me Nov. 15th was the firm date that for the suspension to end. Let's hope it's sooner.

 

[sman]

Here's a different spin from another source: Can somebody please deduce the 4th bullet; I'm having difficulty understanding why an agent will not be paid????

• [FONT=Verdana,Geneva,Arial,Helvetica,sans-serif]Clients can continue to go online, call the company directly and mail in applications now--but agents cannot be involved or be paid![/FONT]

A Medicare recipient can still enroll in PFFS plans. They can use the Medicare website, the carriers website or call the carrier direct to enroll, but an agent can't enroll a person.

The conspiracy theorist in me thinks that this could be a trial run to see how effective enrollments can be without paying a commission to an agent. Why else would some carriers agree to the moratorium and others haven't? Of course, I don't believe enrollments will be near as high as with a sales force. Humana already stated that they believe they will be down 8,000 enrollments per month during the moratorium and that it would reduce their bottom line by $.02 per share. In any event, this is one arrow out of the quiver until November. And that's a shame, because when I had someone that just couldn't afford a supplement, I would offer a MA plan. I was averaging 5-10 MA plans per month. If I can't replace those with supplements, I'm down $1650-$3300 per month in income. I don't hold out much hope that the LOEP will reopen (at least not for the remainder of 2007). Time to shift my focus elsewhere for a few months.

 

[midwestbroker]

The reason that people can still go online or over the internet is there is a control factor there. If you enroll over the phone, the conversation can be recorded. That way CMS and the carrier have control over what is being told to the member.

With an agent in the home, there is no control over what the agent tells the member. CMS wants us all to say the same thing to avoid this in the future.

Agents will have to retest for AEP (as we do anyway), and verification calls will be manditory. Humana and Pyramid already do them, and I think this will be the with the rest of the carriers, as stated.

Humana, in the past, would not pay an agent if the verification call was not performed. They went away from that since the wait time to verify was over 10 minutes during AEP. But now you are talking to a computer so it is a lot quicker. Just put it on speakerphone and it takes the member about 4 minutes to complete. CYA.

 

[sman]

The reason that people can still go online or over the internet is there is a control factor there. If you enroll over the phone, the conversation can be recorded. That way CMS and the carrier have control over what is being told to the member.

With an agent in the home, there is no control over what the agent tells the member. CMS wants us all to say the same thing to avoid this in the future.

Agents will have to retest for AEP (as we do anyway), and verification calls will be manditory. Humana and Pyramid already do them, and I think this will be the with the rest of the carriers, as stated.

Humana, in the past, would not pay an agent if the verification call was not performed. They went away from that since the wait time to verify was over 10 minutes during AEP. But now you are talking to a computer so it is a lot quicker. Just put it on speakerphone and it takes the member about 4 minutes to complete. CYA.

It has to be more than just the verification call that is causing the problem. Otherwise, there would be no reason for Humana or Pyramid to agree to the moratorium since they already do verification calls. Unless of course they aren't asking all the right questions in those calls.

 

[tommyk]

I haVe been selling PFFS with Sterling since March of this year. The company states that they already comply with 4 or the 6 mandates and the last 2 should be completed by June 30. My question is this: Do you believe that CMS will re-certify each company as the meet the mandates or do you believe that they will wait and re-certify all those that meet the mandates on October 1 ??? Any information or links would be greatly appreciated.

 

[midwestbroker]

The verification calls are just one aspect. I am sure CMS will look at the processes in place (internet and phone), tweak them to their likings, and then try and duplicate them in the field.

I am willing to bet that most of the insurance carriers already have standards that meet what CMS wants.

The halt was so CMS has a fresh start with PFFS plans. Most carriers agreed with it to keep up their relations with CMS. The last thing a carrier wants is to make CMS upset.

Carriers still have the ability to sell HMO / PPO / RPPO (regional PPO) plans. That tells me that it is a provider relations issue, with the PFFS plans, and not a general MA plan issue.