Another reason to steer clear of DSNP

[AugustaMi]

I know already why to stay away from DSNP, I didn't learn that fast enough. So I don't need to stay away from DSNP feedback. I already am going forward.

Heres an issue I'll have to deal with tomr, when I'd rather be stirring up better biz.

Lady calls, shes on Humana DSNP. Obviously has medicaid which becomes secondary payor and picks up the rest yada yada.

She was getting her incontinence supplies just fine for months. Then all of a sudden that company sends her a bill for over $200.

I called Humana, was transferred 3 times to wrong dept. Finally, get a seemingly more knowledgeable rep on the phone. She puts me on hold and calls the DME company. She comes back and literally calls DME company rep she talked to a "fricken ***" TWICE (true story I thought wtf, this is recorded line..laughed out loud--I'd prob get my ass handed to me for being unprofessional).

Humana Rep said it was medicaid's fault. Michigan Medicaid and mind you there's like 6 carriers in this area..says they quit using the DME company and won't pay them. The $200 plus bill was "cleared" so client won't be responsible. DME company supposedly eating it.

This was all Friday afternoon, and 45 mins so far. The Humana Rep then put me on hold again, said she was calling Michigan Medicaid, then when she came back said Nothing resolved, that I have to call Medicaid with the client bc they refuse to talk to her and won't talk to me....need to do this with the client present. So far now, no resolution this was ended after 5pm friday, going to pick it up tomr.

That's where it was left. I'm still very new at this, but not new with calling all necessary avenues to get to the bottom of an issue...thats a given no matter what line of biz, but wth. I've never had to deal with Medicaid this way...but I'll do it, no choice.

Any ideas would help. So many of these reps and whatnot get things wrong. Anyone know of an easier way to handle this. Bc even though they fixed the bill and that's not a thing. I still need to figure out who is responsible for her DME. Medicaid I'm pretty sure, but kind of confused.

DSNP/MAPD, yep....ugh...steer clear...very clear.

 

[Travis Price]

Any ideas would help. So many of these reps and whatnot get things wrong. Anyone know of an easier way to handle this. Bc even though they fixed the bill and that's not a thing. I still need to figure out who is responsible for her DME. Medicaid I'm pretty sure, but kind of confused

Honestly? Your job isn't to hand hold with Medicaid. That's the clients job. She just needs to find out who her carrier and who the new DME provider is..

 

[AugustaMi]

Honestly? Your job isn't to hand hold with Medicaid. That's the clients job. She just needs to find out who her carrier and who the new DME provider is..

Haha. Well that makes it easy.

I do get caught up in a lot of the ridic extras. Part of me thinks client will call and say "agent did this or didn't tell me this..." Or I can't remember all the training of whats my responsibility and what's theirs so I just do it all or try to...ugh.

Doesn't matter, you can try to educate til you're blue in the face sometimes and it doesn't sink in.

Humana does train to do as much customer service as you can...It was the Humana Rep doing the calling around so far...lol...i was on hold doing a spread sheet...at least now there's a recorded trail of me trying to fix it.

Youre right. I'm not a social worker (Somarco lol), which is almost always how DSNP views us.This client is so close to my office i didn't even think of just putting it all in her court. I just thought, "oh lets get this sorted". Shame on me

 

[DonP]

Haha. Well that makes it easy.

I do get caught up in a lot of the ridic extras. Part of me thinks client will call and say "agent did this or didn't tell me this..." Or I can't remember all the training of whats my responsibility and what's theirs so I just do it all or try to...ugh.

Doesn't matter, you can try to educate til you're blue in the face sometimes and it doesn't sink in.

Humana does train to do as much customer service as you can...It was the Humana Rep doing the calling around so far...lol...i was on hold doing a spread sheet...at least now there's a recorded trail of me trying to fix it.

Youre right. I'm not a social worker (Somarco lol), which is almost always how DSNP views us.This client is so close to my office i didn't even think of just putting it all in her court. I just thought, "oh lets get this sorted". Shame on me

Thats just the start . I moved a dsnp from Humana to United 8 days ago with better food card . She called me last week and said where’s her new food card . She said “ she ain’t got no food and she gets her food on the first of the month “ . I told her it takes a few weeks to get. She said she can’t wait . So it could be a complaint . On the other hand my friends been doing 95% duals for 6 yrs . He has over 950 on books . That’s about $23 k a month . But I want the pivot to middle class going toward . What scares me is how many people I replace that have agents . But they bold with better plan . That could be me on other side .

 

[Travis Price]

Thats just the start . I moved a dsnp from Humana to United 8 days ago with better food card . She called me last week and said where’s her new food card . She said “ she ain’t got no food and she gets her food on the first of the month “ . I told her it takes a few weeks to get. She said she can’t wait . So it could be a complaint . On the other hand my friends been doing 95% duals for 6 yrs . He has over 950 on books . That’s about $23 k a month . But I want the pivot to middle class going toward . What scares me is how many people I replace that have agents . But they bold with better plan . That could be me on other side .

It absolutely will be... DSNP is a flimsy book.

Most people you sign up in the +65/non-DSNP will much less likely flip on you for years.

 

[Travis Price]

Humana does train to do as much customer service as you can...It was the Humana Rep doing the calling around so far...lol...i was on hold doing a spread sheet...at least now there's a recorded trail of me trying to fix it.

If it was a quick fix, I'd agree.. but she should at least have the Medicaid card and know who the insurer is...

The problem is that there's a thin line between serving the book and becoming a crutch. Once you're a crutch you're losing money doing that much service work.

You might get referrals, but those referrals are likely to be DSNPs that are going to make you a crutch too..

 

[Northeast Agent]

DonP said:

I moved a dsnp from Humana to United 8 days ago with better food card . She called me last week and said where’s her new food card . She said “ she ain’t got no food and she gets her food on the first of the month."

Does she qualify for/receive SNAP benefits as well?

 

[AugustaMi]

If it was a quick fix, I'd agree.. but she should at least have the Medicaid card and know who the insurer is...

Her info is on my office desk. If memory serves me, she said she did call and found out her Mclaren Medicaid plan was changed without her knowing and now she doesn't know what she has...bet it could be Molina or Meridian, either of which will be worse than McLaren. Of course it gets very slippery bc those have enrollment periods too, and she can't just switch back. Could even be a bigger issue than she knows now, like does her Doc take the new Medicaid...lol On and on the mess could go...

To tell a DSNP enrollee, sorry not sorry, not my job, call your Medicaid seems silly. I did though reiterate the differences btwn Medicare (part A, part B and included how DME works and the rest, and Medicaid, even how it would work with or without one or the other. She didn't get it.

So many issues with these. "Here we will give you free food card, but now pay for your incontinence supplies bc your state switched ya out of your medicaid to a new one"--untangling it is a pain. I don't like it but glad she called me first.

I only have 5 or 6 DSNP and already know I don't want more. I've been leaving these on the table every single week for weeks now.

I think how I'll handle this is this: Stop by her house bc she's less than a mile from my office. Then call whatever medicaid she has, and ask them what's up with her DME and who should she reach out to to get that back going.

Humana said, "have her use her remaining $69 on her OTC" for her supplies. yah ok, her supplies are over $200. Wrong answer.

She's going to need her supplies and I think the issue here is finding the DME supplier that her medicaid works with. Humana tried and that wasn't helpful.

Other issue is this: Is Humana at all responsible for any of it? Do I coordinate the DME with both Humana and Medicaid. This confuses me. Maybe I'm just not getting it nearly as much as I thought I did. ugh. The more I think about it the more confusing it gets.

I don't leave things undone, so for now I'll do what needs to be done to help her, but going forward this DSNP game isn't for me. I'd 100 times over rather work with someone who gets there's OOP and 20% responsibility. After tomr morning it's in her court.

I posted this bc this is yet another headache that can arise. I'll post the resolution when/if I find it.

Hope this is understandable...lol. My 5 yr old gdaughter glued to my hip on her tablet and will not quit talking. lmao. ugh.

 

[Travis Price]

To tell a DSNP enrollee, sorry not sorry, not my job, call your Medicaid seems silly. I did though reiterate the differences btwn Medicare (part A, part B and included how DME works and the rest, and Medicaid, even how it would work with or without one or the other. She didn't get it.

Every person has their own way of handling this business. Just remember the clients you keep are likely the referrals you'll get.

I would absolutely say that I can't help them because DHHS will not talk to me. Give her the number and tell her to give me a call once she knows who it is.. However, why do it when someone else will handle it for them.

DME isn't that difficult once she knows who she should see.

She gets notified when they switch providers from DHHS by mail. She may have thrown it out. Most of these DSNP guys aren't working. They have the time to handle their business.

However, as I said.... it's your business, so who am I to say "Don't do that."

 

[AugustaMi]

Every person has their own way of handling this business. Just remember the clients you keep are likely the referrals you'll get.

I would absolutely say that I can't help them because DHHS will not talk to me. Give her the number and tell her to give me a call once she knows who it is.. However, why do it when someone else will handle it for them.

DME isn't that difficult once she knows who she should see.

She gets notified when they switch providers from DHHS by mail. She may have thrown it out. Most of these DSNP guys aren't working. They have the time to handle their business.

However, as I said.... it's your business, so who am I to say "Don't do that."

Thanks. I might just do it this way.

Since I started this leg of my career, it's been interesting. Since the beginning, I did everything I could to learn as much as I could. This meant going back out and setting up accounts, helping with each step, DME, pharmacy, etc. Not so much to be a social worker type or "the best agent" or whatever, but more to learn what clients experience from their end. It was actually more self serving than that...More for me to get a sense of conviction in what I was doing and to experience if it was a good enough thing to even be "selling". I can't "sell" a thing if I don't have conviction in it and I just wasn't sure in the beginning...had to see it from as many angles as I could. Now I've kind of gotten stuck on that speed.

Much of what we do is learning as we go. I should stop this b4 it just becomes a bad habit. It kind of already is. haha. Your post is actually a reminder and a good thing for me. Thanks.

That said after I posted this thread it dawned on me that I've been doing more MA only plans (Honors and Eagle--The HAP one when they want the extra Delta dental). I like this niche---don't even need to run Rx. I've been doing just these and new to Medicare. Almost All of what I've done in past two months is one or the other.

I'm glad i learned DSNP isn't my thing...now I know why the organization I'm with doesn't really like it, although my FMO touts the crap out of it. Typical, need to learn some things the hard way...haha