Who to trust on RX comparisons

[goillini52]

I pay $15.99 for FEX Quotes so if I could get a FE quoter and a PDP drug cost estimator it would be worth $25. Thanks y'all for the advice.

Yes, for $9 more a month you'd add MA/PDP, Med Supps and HIP and a CRM and call / Zoom recording.

 

[sshafran]

https://www.sparkadvisors.com/

Not to go all fanboy on this but these guys are next level over any other outfit I've dealt with through the years. All processes are tech-integrated (SOA signing is like 2 clicks, for example), they send out birthday cards and AEP cards/emails, they run Rx comparisons and send me the results (not that I trust anyone's work but my own), they co-op all of my various marketing ventures (not sure if that's available to everyone), and they will handle any service work I throw at them.

Here's a recent case involving a ridiculous UHC eff-up:

My ticket to Spark-

UHC has it in their system that member is on the Patriot plan. Attached files show that the application was for the Walgreens Plan 1 PPO, effective 7/1/2022. I've also attached a copy of the member's UHC card showing the Walgreens Plan 1 PPO.

I have attempted to fix this with UHC to no avail. One of their suggestions was to simply rewrite the member during AEP, however this would result in a Part D LEP since the Patriot plan has no Rx coverage and the member has no other creditable drug coverage. This would be a ridiculous 'fix' anyway as it is clear that UHC has dropped the ball in some manner.

I would very much appreciate if one of my Spark heroes can reach some type of resolution with this and get the member made whole. Let me know if you need ANY add'l information.

The response I get from a Spark rep--

Spark (Alejandro D) Mon, Oct 17, 2:56 p.m.

Called UnitedHealthcare, 877-370-2843, Ebony advised that the member is currently enrolled in the AARP Medicare Advantage Patriot Plan. Ebony advised that for the Walgreens Plan 1, the effective date and termination date listed on the policy is 07/01/2022. Their system reflect the Walgreens Plan 1 as never effective.

Ebony transferred me to Jacqueline advised that under Medicare, the Walgreens Plan 1 is what is active with Marx and I would have to speak with Customer Service to fix the information within UHC's system.

Jacqueline transferred me to customer service, Nicole advised that she has no way of updating the member's information to reflect the Walgreens plan. Nicole initiated a conference call with the enrollment department. While on the conference call with the enrollment department, the call disconnected.

Called UnitedHealthCare again, 877-370-2843, however I received a busy dial tone and the line disconnected.

Spark (Alejandro D) Mon, Oct 17, 4:05 p.m.

Called UnitedHealthcare, 877-370-2843, Cassie from customer service transferred me to the tier 3 department, Lisa advised I would have to contact the producer services department: 888-848-3375.

Called producer services, 888-848-3375, however, it was an IT help desk phone number.

Called UnitedHealthcare again, 877-370-2843, Harley advised that the request to have the plan changed to the AARP Medicare Advantage Walgreens Plan 1 has been submitted and is in process. The update will be retroactive as of 07/01/2022 and no changes to the broker of record will be made. The update will be reflected in UHC's system within 48-72 hours. Call reference number: S-571155997

Next steps

Hi Bill, I contacted UnitedHealthcare and was able to confirm that the member's plan will be retroactively updated to reflect the United Healthcare AARP Medicare Advantage Walgreens Plan 1 as of 07/01/2022, with no changes to the broker on record. The update will be reflected in UHC's system within 48-72 hours. They provided me with the following case reference number: S-5711XXXX. Let me know if I can be of any further assistance. Thank you, Alejandro

Those are hours I never wasted and brain cells I never felt withering away. It's like having an entire back office on retainer and yes, I am a proud and thrilled fanboy.

That's impressive.

 

[somarco]

True. But if you give out too many bad answers, that book might become less substantial over time.

The answers are not mine, they are from the software. It is more accurate than dot guv.

And since the final formulary update comes after 12/7 and is applied by 1/1 you will never be assured of 100% accuracy.

A few years ago, when dot guv was the only resource, many of the SilverScript copays were off. One lady got really pissed when her BP med was a lot higher than the dot guv report. I sent the old report and the new one from the current year which showed the higher copay. I explained there was no way for me to know the price would increase that much and she agreed.

If you can document your information I find that most folks are forgiving.

 

[DonP]

https://www.sparkadvisors.com/

Not to go all fanboy on this but these guys are next level over any other outfit I've dealt with through the years. All processes are tech-integrated (SOA signing is like 2 clicks, for example), they send out birthday cards and AEP cards/emails, they run Rx comparisons and send me the results (not that I trust anyone's work but my own), they co-op all of my various marketing ventures (not sure if that's available to everyone), and they will handle any service work I throw at them.

Here's a recent case involving a ridiculous UHC eff-up:

My ticket to Spark-

UHC has it in their system that member is on the Patriot plan. Attached files show that the application was for the Walgreens Plan 1 PPO, effective 7/1/2022. I've also attached a copy of the member's UHC card showing the Walgreens Plan 1 PPO.

I have attempted to fix this with UHC to no avail. One of their suggestions was to simply rewrite the member during AEP, however this would result in a Part D LEP since the Patriot plan has no Rx coverage and the member has no other creditable drug coverage. This would be a ridiculous 'fix' anyway as it is clear that UHC has dropped the ball in some manner.

I would very much appreciate if one of my Spark heroes can reach some type of resolution with this and get the member made whole. Let me know if you need ANY add'l information.

The response I get from a Spark rep--

Spark (Alejandro D) Mon, Oct 17, 2:56 p.m.

Called UnitedHealthcare, 877-370-2843, Ebony advised that the member is currently enrolled in the AARP Medicare Advantage Patriot Plan. Ebony advised that for the Walgreens Plan 1, the effective date and termination date listed on the policy is 07/01/2022. Their system reflect the Walgreens Plan 1 as never effective.

Ebony transferred me to Jacqueline advised that under Medicare, the Walgreens Plan 1 is what is active with Marx and I would have to speak with Customer Service to fix the information within UHC's system.

Jacqueline transferred me to customer service, Nicole advised that she has no way of updating the member's information to reflect the Walgreens plan. Nicole initiated a conference call with the enrollment department. While on the conference call with the enrollment department, the call disconnected.

Called UnitedHealthCare again, 877-370-2843, however I received a busy dial tone and the line disconnected.

Spark (Alejandro D) Mon, Oct 17, 4:05 p.m.

Called UnitedHealthcare, 877-370-2843, Cassie from customer service transferred me to the tier 3 department, Lisa advised I would have to contact the producer services department: 888-848-3375.

Called producer services, 888-848-3375, however, it was an IT help desk phone number.

Called UnitedHealthcare again, 877-370-2843, Harley advised that the request to have the plan changed to the AARP Medicare Advantage Walgreens Plan 1 has been submitted and is in process. The update will be retroactive as of 07/01/2022 and no changes to the broker of record will be made. The update will be reflected in UHC's system within 48-72 hours. Call reference number: S-571155997

Next steps

Hi Bill, I contacted UnitedHealthcare and was able to confirm that the member's plan will be retroactively updated to reflect the United Healthcare AARP Medicare Advantage Walgreens Plan 1 as of 07/01/2022, with no changes to the broker on record. The update will be reflected in UHC's system within 48-72 hours. They provided me with the following case reference number: S-5711XXXX. Let me know if I can be of any further assistance. Thank you, Alejandro

Those are hours I never wasted and brain cells I never felt withering away. It's like having an entire back office on retainer and yes, I am a proud and thrilled fanboy.

I have this type back end service with my fmo plus full 100% marketing with no coop . Without back end help in Medicare you’ll be bogged down day in day out .

 

[straightnochaser]

Caveat, not an agent.

That becomes a time problem for agents with a substantial book.

Yea maybe, but when you're talking about a $6k difference you do what you need to do for your client or let someone else take them who will.

 

[kgmom219]

I'm still using Medicare.gov

If its a difficult list, which is probably around 20%, I will check it. But reality is that its all the same drugs. I'm checking Eliquis, Xarelto, Restasis and Xiidra on carrier sites October 1. That leaves me with about 5% that need a double check.

Postives:
Since I actually do "sell" Part D (and MAPD), I get to make fun of the disclaimer. And since I screen print it, save it and email it, if there's an issue post January 1, Medicare will allow a change if you can prove the Plan Finder was wrong. They won't do that for the other sites.

Negative:
I am retyping the damn lists every year. Total PITA.

 

[somarco]

Negative:
I am retyping the damn lists every year. Total PITA.

True that . . . which is why I stopped doing ANY PDP work for a few years. Started up again last year when I signed on with S&S

 

[sshafran]

Had a lady today in OH w Memantine & Solifenacin Succinate + some generics

Told her this:
WellCare $11.20/mo 505 ded
Both are Tier 3 @ $132 Max for 90 day before gap.

UHC (Saver +) $50/mo $505 ded
Both are Tier 3 @ 17% for 90 day before gap.

Sent her both summary of benefits and told her to let me know which one she wanted.

No illustrations. No printouts. Just tiers and premium and SoB.

She said how do I know which is better?

I said "I do not know, nor can I predict, what 17% will cost you because I don't know what pharmacies will charge for these meds in 2023. You just need to decide, and let me know."

I elaborated a little.
If the pills are expensive, the $50 drug plan is better. If the pills are cheap, the $11 drug plan is better. But I don't sell drugs and I don't know their pricing - their prices today are not set in stone so really no one knows.

That's all I can tell you.

 

[sshafran]

Had a lady today in OH w Memantine & Solifenacin Succinate + some generics

Told her this:
WellCare $11.20/mo 505 ded
Both are Tier 3 @ $132 Max for 90 day before gap.

UHC (Saver +) $50/mo $505 ded
Both are Tier 3 @ 17% for 90 day before gap.

Sent her both summary of benefits and told her to let me know which one she wanted.

No illustrations. No printouts. Just tiers and premium and SoB.

She said how do I know which is better?

I said "I do not know, nor can I predict, what 17% will cost you because I don't know what pharmacies will charge for these meds in 2023. You just need to decide, and let me know."

I elaborated a little.
If the pills are expensive, the $50 drug plan is better. If the pills are cheap, the $11 drug plan is better. But I don't sell drugs and I don't know their pricing - their prices today are not set in stone so really no one knows.

That's all I can tell you.

I sell insurance with listed copays, tier levels, deductibles, contracted pharmacies, and coinsurance.

I don't sell estimated yearly costs on products (pills) sold by pharmacies with unknown variables and price fluctuation.

 

[somarco]

She said how do I know which is better?

Fair question.

My clients (all Medigap + PDP) like to make their budget out for the year. They want as much detail as possible for Part D.

I doubt the "short form quote" with tiers and a premium will fly with them.

Many ask about the donut hole, especially those that hit it this year.

I do give detailed reports while explaining these are estimates based on TODAY'S formulary.

Some of these same folks ask how much premiums will be for 2023. Of course that has no answer either but a bit easier to offer a workable response.