Too Many "Experts"

[Joe Moore]

The home health agencies are the worst for us around here. They bash MA plans to their clients non stop and tell their clients that they can't come to their house anymore if they sign up on an Advantage plan (which is completely untrue).

It is usually a good indicator of a home health agency that is making unneccessary visits to patients just to bill medicare. They know that an MA company is going to be a little more strict on unneccessary visits.

I've never filed a complaint, but I should. Who would you complain to about a private home health agency?

We have had similar problems with the Home Health Agencies.
It appears they are under the jurisdiction of the State Board of Health in OK. This is where I would start:
Oklahoma State Department of Health - OSDH Home
- - - - - - - - - - - - - - - - - -

So no more Tenn Care and she can't afford the MA co-pays....So how will she afford the medicare cost...So now she only has original Medicare....Think she will like the first $155 or part b costs?

I am not a fan of MA plans mainly due to the insane marketing rules but I agree they can be appropriate for some people...And this person sounds like a good fit, income just above medicaid. I would not worry too much about this client my bet is she ends up with a medical condition her assets go south and back to Tenn Care she goes. I wouldn't work too hard for someone that can't afford $13 a month for her insurance coverage I've found them to be the type to spend a lot of time on due to their income levels but not get a lot back in return...

VaDwayne, I bet his problem is a lot of people call themselves good christian people only to lower peoples hesitation factors....I know personally when someone tells me they are a good christian I cover my wallet...If your a good christian you don't need to be telling people that....however In this case what does the Pharmacist have to gain? My bet is he has had a lot of people on MAPD plans with inferior formularies which is why he developed his belief that anything with advantage in it was bad because that is all he would deal with...

Joe sorry for your son, tell him to move on when this client realizes she wants back on MA she will be outside her enrollment period and will have to wait. Tell him he can't fix stupid and to move on she might come back or she might not.

By filing a complaint against him with his governing board, they will probably choose not to get involved. But, my thought is by hassling him with having to deal with it, he may think twice before he starts bashing without knowing anything he is talking about.

The lady has been off Tenn-Care 4 months, and is watching bills pile up that she cannot pay. This is why she came to us in a frantic fit. We are not too concerned about keeping her as a client, but want to try to make the pharmacist think twice before giving wrong advice. This is the same pharmacist that told me there was no difference in any of the Part-D plans, just some companies charge more than others. He really thought this. I have known him 35 years and he has had a lot of ethical issues come up. Once losing his license for either one or two years. I do not know all the details, but he has lived on the edge quite a few times.

We still have her as a client in a Part-D only plan, so we may not be through with her.

As long as she receives assistance, she is not bound to the election periods. She has a permanent SEP (can change, add or subtract plans anytime). Two weeks ago I had to intervene when she gets on the phone and enrolls in a MAPD plan that would not cover 2 of her drugs. She then comes to us crying about how she had messed up.

As so many on here have said: "Fixing stupid is impossible". In this situation, the statement also applies to the pharmacist.

 

[DHK]

How much time are you spending on this? Revenge can be "sweet" but it can be costly.

Jim Rohn has a recording about "Building a Network Marketing Business" and he talks about what you can do when someone refuses your advice (or seeds as this related to the parable of the sower). He says "the birds" got to them.

Now, you can do one of two things:
- You can chase the birds. Here's the problem: you leave the field.
- You can continue to sow more because there aren't enough birds to get all of the seed.

So, say "Next!" and move on. It just doesn't seem worth the trouble.

 

[xrac]

How much time are you spending on this? Revenge can be "sweet" but it can be costly.

Jim Rohn has a recording about "Building a Network Marketing Business" and he talks about what you can do when someone refuses your advice (or seeds as this related to the parable of the sower). He says "the birds" got to them.

Now, you can do one of two things:
- You can chase the birds. Here's the problem: you leave the field.
- You can continue to sow more because there aren't enough birds to get all of the seed.

So, say "Next!" and move on. It just doesn't seem worth the trouble.

Mark 4

The Parable of the Sower

1Again Jesus began to teach by the lake. The crowd that gathered around him was so large that he got into a boat and sat in it out on the lake, while all the people were along the shore at the water's edge. 2He taught them many things by parables, and in his teaching said: 3"Listen! A farmer went out to sow his seed. 4As he was scattering the seed, some fell along the path, and the birds came and ate it up. 5Some fell on rocky places, where it did not have much soil. It sprang up quickly, because the soil was shallow. 6But when the sun came up, the plants were scorched, and they withered because they had no root. 7Other seed fell among thorns, which grew up and choked the plants, so that they did not bear grain. 8Still other seed fell on good soil. It came up, grew and produced a crop, multiplying thirty, sixty, or even a hundred times."

Just like selling insurance. A person has to find the good soil (prospects).

 

[Joe Moore]

How much time are you spending on this? Revenge can be "sweet" but it can be costly.

Jim Rohn has a recording about "Building a Network Marketing Business" and he talks about what you can do when someone refuses your advice (or seeds as this related to the parable of the sower). He says "the birds" got to them.

Now, you can do one of two things:
- You can chase the birds. Here's the problem: you leave the field.
- You can continue to sow more because there aren't enough birds to get all of the seed.

So, say "Next!" and move on. It just doesn't seem worth the trouble.

We are spending nothing ($0.00), unless you consider a couple hours of time.

 

[somarco]

You can run into the same thing with HO "experts".

This has happened more than once to me, and always after the fact. Sometimes it is too late to unwind.

A policy comes up for renewal and the client decides to call HO about options to keep the premium in line. (You should know that many carriers do not notify agents about renewals and do not provide a copy of the renewal action or options. Even if you put it in a tickler file the carrier can surprise you, like Aetna did, and send out a mid-year change).

So the renewal goes out, the client calls HO and talks to some twerp who worked at a fast food place last month and kept forgetting to ask the customer if they wanted to super-size their order. Now they work for Big Crappy Health Insurance and all they still know how to do is take the customers order.

Policyholder - My premium increased by $80 and I can't afford it.

Silly Suzie - We have another plan with a lower deductible that is $10 less than you are paying now.

Policyholder - That &*#($ agent didn't tell me about that plan. I'll take it.

Of course what the PH didn't ask and doesn't know is they just gave up an Rx benefit and picked up more OOP on a cat claim. SS doesn't know that either, and isn't paid to give advice, only to take an order.

It doesn't do any good to complain to HO because they don't care if the client renews with less coverage (albeit at a lower premium). In their view, they kept a PH from going somewhere else.

Forget the legal battle if the PH later develops an illness that actually requires an expensive medication, only to find out then their new policy doesn't cover it.

 

[arnguy]

Well, there is nothing like a good Christian to set things straight. Anytime someone brings religion into business....beware!!!

 

[Joe Moore]

Well, there is nothing like a good Christian to set things straight. Anytime someone brings religion into business....beware!!!

amen brother!

 

[theinsuranceman]

VaDwayne, I thought you were a Christian. You're not sounding like one.

 

[sokybrian]

Well, there is nothing like a good Christian to set things straight. Anytime someone brings religion into business....beware!!!

I couldn't agree more brother....

Wait a minute.... Has anyone seen my checkbook? I just had it in my hand....

 

[ksigmtsu]

Why not use her wanting to cancel as a way to move her into a medsupp. She's currently still GI because of the tenncare dropping, I'd just say "ok, if advantage plans are unacceptable here is what is available in order to make sure you don't lose all your savings or your home". Or just say "is your pharmacist or your church going to pay your medical bills when you owe a couple thousand? This plan I signed you up for will."

Did you fully explain the negatives on the PFFS? I honestly explain the entire downside of PFFS as part of my sales procedure on those plans, my thought being it allows me to try to sell a medsupp instead and at the same time insulates from people later on hearing that "advantage plans are bad" and that being the final word. If you already told them they are bad in certain ways, here is why, here are the benefits and negatives and if you want an advantage plan still this is the one I believe is the best it works out better.

The stupid part here is that the 13$ BlueCross plan you're using is one of the best values in the state for an MA other than the PPO plan they have in certain zips. My great aunt cant afford a supplement, doesn't go to the doctor much and lives in a county where they don't have the PPO and that's the plan we put her on. That BlueCross sapphire 0$ plan is probably the best MA in the state hands down.

I'd wait till the N rates for MOO came out, she might be fine with those they should be out in the next week or two and they're starting at like 67 dollars for age 65. I had a FMO send a advertising out that had an advance copy of the rates if you don't already have them. Still not DOI approved but they're pretty nice. Tops out at age 91 at 124, which is basically the same point AARP caps at at age 75.

Downside being I expect because they're making it GI that they're planning to get a bunch of people on the plan and then jack the rates up.