Pyramid: Today's Options MA and MA-PDP

[honestagent]

Hi again.

I would like to hear from those kind folks who are willing to share their experiences with this company, which includes: the good, bad, and indifferent assuming you'd like to share.

Also, are you finding that doctors, hospitals, and specialists are receptive to the plan?

Thank you in advance.

 

[sman]

Hi again.

I would like to hear from those kind folks who are willing to share their experiences with this company, which includes: the good, bad, and indifferent assuming you'd like to share.

Also, are you finding that doctors, hospitals, and specialists are receptive to the plan?

Thank you in advance.

I personally like Today's Options. Here in Georgia it seems to be one of the better plans. I really like the Premier Plan. I generally don't sell their MAPD plan (price for MA Premier is $35 for MA Premier Plus - the MAPD plan is $80) so the Rx benefit is $45 extra. I think you can do much better by packaging their MA plan with a stand alone PD plan from another carrier. The Premier plan has a hospital copay of $150, PCP $5, specialist $15, outpatient surgery of $25 or $50 depending on where performed. It just seems to really limit the out of pocket expense. And for $35 per month, it's within many people's price range. They do have a lessor priced plan ($12 per month), but the copays are higher for the procedures listed above.

The ony real issues I have is that some providers are uneducated about MA plans in general. Once they know it's a Private Fee for Service, that usually alleviates any concern. And from time to time the verification call is bothersome (in that they don't always speak English very well).

You can do the enrollment online and then perform the verification call (I usually just do a 3 way call with the client). Commissions are paid VERY quickly. I really don't know how fast, but it's usually less than a week. It seems like every other day I'm having commissions direct deposited to my account.

I really haven't received any complaints and hope that's a good sign.

 

[Bob_The_Insurance_Guy]

I have sold a handful of Pyramid's products. Too soon to say whether or not they are good plans, because my clients have not had the time to utilitze all the benefits of the plan.

The way to avoid any physician not accepting a particular insurance company, when dealing with Medicare Advantage Plans, is to call the physician's office, and ask, "For current patients of yours, do you coordinate with Medicare Advantage plans administered by (Pyramid, Universal, Humana, etc.)?".

The response you will usually get is, "for current patients, yes."

Because CMS is the one spearheading the Medicare Advantage Plans, I'm afraid proper promotion and a head's up was not taken. You see, government doesn't know how to "sell" a product or service. The longer Medicare Advantage Plans are in place, the less resistance you will see.

The easiest way to explain Medicare Advantage is: It's nothing more than Major Medical Plans for Medicare Beneficiaries. Doctor Copays, OOP limits, medication copays, etc. Just like the plan they were on when they worked for an employer.

Predictability vs. Non-Predictability (Original Medicare)

Physician's were not included in the loop, when Medicare Advantage Plans were rolled out. CMS should have conducted seminars last year, and included physicians and their staff, but they didn't. That's government for you.

Pyramid is one of the companies that actually specializes in Medicare Advantage Plans, so they know what they are doing. Others are dipping their toe in the water, and will probably be out of the MA game before long (just as they were with LTC).

The more support and on-going training you get from a company, the better their product. Pyramid has a weekly Monday teleconference call. It's just a 45 minute call, but it keeps you up to date, and let's you hear what others have to offer. They are also one of the few companies that makes you do a verification call at the appointment. I think that's a big plus. It adds credibility, and helps you avoid any "he said/she said" with the applicant. Very few other companies are doing that.

You might also look into Coventry, Instill (a division of the evil empire), and CareImprovement Plus.

Avoid: Universal health care, BCBS, Humana, Aetna. Not very good support, even less field assistance, and probably toe-dippers, all.

Kaiser Permanente has a good plan, but does not work with agents/brokers. It's a shame. Their MA Plan is marketed directly through Kaiser Employees, and not even all of them.

 

[Guest]

Bob, excellent post and good advice on handling MA issues!

Today's Options is my second favorite MA plan; second only to Security Choice by Unicare.

As a company for agents AmerProg (Pyramid) is fair; but they are getting better. I too hate the verification calls to the Phillipines.

 

[sman]

The way to avoid any physician not accepting a particular insurance company, when dealing with Medicare Advantage Plans, is to call the physician's office, and ask, "For current patients of yours, do you coordinate with Medicare Advantage plans administered by (Pyramid, Universal, Humana, etc.)?".

Bob, I've found it can take more than that. I recently had a client call me and tell me that her ob gyn didn't accept Today's Options. I won't go into all the details, but suffice it to say, they do. Corporate (Wellstar Physicians Group) sent out a memo stating they didn't take Medicare Advantage HMO or PPO but did take PFFS plans such as Humana and SecureHorizons. The local office thought that meant they only accepted those two plans.

Avoid: Universal health care, BCBS, Humana, Aetna. Not very good support, even less field assistance, and probably toe-dippers, all.

I can understand the comment about Universal. And even Aetna and BCBS (at least here in Georgia). I don't personally care for Humana, but they are hardly a toe-dipper. They were first to the scene with MA plans here in Georgia. I believe they were the largest provider of MA and PDP plans in the country until United Healthcare bought PacifiCare (i.e. - SecureHorizons).

 

[midwestbroker]

I have sold a few of their plans. So far so good. The IMO I use pays weekly (as long as you verified the sale), so I do not have a pay issue.

There is a remote provider relations agent here in Kansas City that works with Pyramid. If I do run into an issue, I can just shoot her an email and she takes it from there.

For the plan, the hospital co-pay on the premier plan is the best in Kansas City and the rates are low ($35 for a stand alone PFFS).

I like them.

The bad is that their customer service hold times can be long, but who's isn't now and again?

 

[honestagent]

All of you have provided much valued input and I greatly appreciate it.

Bob: Thanks for your input on how to overcome the doctors' response. I have had some difficulty overcoming that one. I'll try it and see how it works.
The only problem here is: What if I call and I cannot get the billing specialist right there and then at the table. And yes this has happened to me. How do you overcome that one if the deal breaker is, "l'll sign up but only if my doctor takes this?" That's going to be paramount for me! I know it, especially when I move out of this area to sell this product in a different area where it is not zero premium. I do think they have a great product for PFFS at $35.00. That is stellar as long as they live up to their contract!

Sman: Thank you too for your input here as well. Something that you experienced with your ObGyn client was something too I experienced only this billing specialist would NOT here me out and hung up on me?!?!?! What the hey!!!??? She would not even give me a chance to finish 2 sentences!!! Needless to say, I didn't sell that case either.
Again the deal breaker in that house is: "if my doc accetps this, I'll sign up. And if not, I'm not."

I don't know what to do here. I agree with Bob how the government and or insurance companies did not properly educate and market to one of thee most pivital niches before all this came out: the providers!

So, my million dollare question to you guys is what do you say to the client / prospect if he or she is only hesitant because of:

" my doctor does not accept this, I'm not signing?" (for some, they would rather stay on original medicare with nothing or keep a very expensive supplement (while being super healthy) than switch. They love their doctors. I can appreciate that. I can. I mean, who am I to tell someone where to go. But at the same time too, it's killing their pockets. How do I overcome this?

Any suggestions?

Also, are you finding that a lot of doctors know of Pyramid allready?

Midwest, thanks too for the heads up on phone.

Anything else that you guys have experienced so far that I should be aware of?

 

[Guest]

If they understand they are paying more than they need to but still want to keep their supplement because their doctor does not accept the MA plan there is only one thing to do: pack up and go to the next appointment.
No way would I force this issue or try yo sell the MA at this point.

 

[policy doctor]

I think Pyramid had a letter you could download and give, or mail to the doctor's office, concerning how the medicare advantage pays. I noticed all these companies have a sheet for the client to write 2-3 doctor addresses and phones, plus a hospital of choice, and I assume the company sends out a form letter accordingly.

That would be their way of marketing directly to the providers.

 

[g1bass]

Every client presents a different set of needs,whether I like a company or not I tend to get licensed with every one of them in my area regardless of commission. There is always someone who hates, Humana or loves United- they all have customer service problems esp during open enrollment, count on Murphy's law to be in effect.

Doctors can be resistant to accepting PFFS not because its bad for their practice but because the geniuses in their billing departments dont want to have to do any extra work- it's ultimately easier to just bill the PFFS, but they are trained to bill medicare and a supplement and so anything else is a bother and they simply dont want to be bothered.

Case in point,when Part D came out I offered to give doctors offices a free formulary to each plan I was representing to help transition their patients. Every doctors office I called told me they were too busy to bother checking formularies and patients would just have to take whatever the doctors prescribed. They wonder why insurance premiums go up!