Pyramid: Today's Options MA and MA-PDP

[honestagent]

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!

This is absolutely worthy of saying. Thank you. And Policy Doctor, thanks for the heads up on the form we can give them. I have to find that.

 

[honestagent]

Hey, btw, are you guys having them directly drafted pac or deducted from social security. I know there are issues with the social so I'm thinking the pac method is better. Is that what you guys and gals have been doing for Pyramid?

 

[midwestbroker]

PAC. I have had lots and lots of problems with SS. There have been numerous times when clients get a letter from the carrier that their payments are behind, they have been drafted from their SS check, and never forwarded to the carrier. Then they have to pay the carrier, call SS and tell then what happened, and wait to get the money back from the carrier when SS gives them the money.

That was not fun to type much less deal with.

 

[honestagent]

You know, I have had similar issues and I was not sure if it was just a particular company or companies but I'm going to do Pac too. Thanks Midwest.

 

[Cenla Agent]

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.

I appreciate your practice in finding out if providers accept the PFFS. If more agents did this, there would be a lot less problems in the MA market. Most of the points you made are on target.

However, Humana certainly isn't a toe dipper in the MA market but in fact has been it from the beginning. IIRC they have more members enrolled in MA plans in Fla. than all other companies combined and are second only to United nationwide.

Pyramid is making a big push to get into the MA market, but this is the first year that they have offered their plan in more than a handful of states. They are also a much smaller company than many of the major players like Humana and United and are apparently going for broke with the push into the MA market. I'm glad you have had a good experience with them so far, but if anyone is a "toe dipper" it's Pyramid, not Humana.

Regarding support, if you are independent and had sold Humana before, the problem may have been with your MGA, not Humana. I can call the Agent Service Center and get basically any question answered almost immediately.

 

[Frank Stastny]

The main problem I have had is with the people working for he doctor. I had scheduled a routine physical for earlier this week. When I got to the doctors office and checked in at the front desk I asked if the doctor accepted Pyramid's Today's Options. The girl immediately said no. I then asked if the doctor accepted Advantage Plans, again she immediately said no.

I then asked if she knew what Advantage plans were. This time she didn't immediately answer. In fact she didn't even answer at all. I then told her they are plans for people on Medicare where the company is billed instead of the doctor having the claim filed with Medicare. Her answer was, "I think we have a couple of patients who have those". (It is a very small doctors office and there are only a couple of people working there.)

When I got in to see the doctor, a friend of mine, I aske him and he said of course I do. I suggested that he inform his staff what Advantage plans are and that he takes all of them.

I sold a Supp policy to a woman who had an HMO. She was very concerned if her doctor was "on the list" and would accept a Continental Life Med Supp policy. I again explained the difference between an HMO and a Med Supp policy. Apparently she didn't believe me so she called her doctors office and asked. She insisted on making the call herself. When when she hung up she said, "the girl said the doctor doesn't accept Continental Life". I finally got her to understand and then called the doctor back.

You have to be so careful how you ask questions when calling a doctors office. And, be especially careful if the prospect wants to make the call.

 

[wilkin]

I've had the same problem as Frank many times. Several times a year our local hospital, owned by a large market-dominating healthcare system, runs an "image" ad in the newspaper proudly stating "we accept the following health plans..." And then they list the names of each HMO and PPO group they accept. Of course none of the Med Supp company names are on the list except BC & BS! I've found that people actually cut out those ads and when I come over to discuss a Med Supp they want to know why the local healthcare system doesn't accept them!

 

[policy doctor]

"Too many cooks spoil the pot." There are so many choices now for the Medicare recipient that they are getting spun inside that product revolving door. Career agents take care of their clients. The Quick-Buck artists glory in this confusion and just skim and scam. I agree with Pyramids' prudent check and balances.

 

[senior-advisor-indiana]

Career agents take care of their clients

I think career agents are selling the company not the product. Be independent and have the best product for your clients.

 

[Guest]

"Too many cooks spoil the pot." There are so many choices now for the Medicare recipient that they are getting spun inside that product revolving door. Career agents take care of their clients. The Quick-Buck artists glory in this confusion and just skim and scam. I agree with Pyramids' prudent check and balances.

What do mean by this? Are you saying that too many choices is a bad thing? Are you also saying captive agents take care of their clients better than independent agents?