Disgusted with Humana this Year for AEP

[FLM2]

Problem is, the new LPPO lists diagnostic tests and procedures as $0 to $200 OR 20%, with not an explanation as to what qualifies for each option. Outpatient X-rays as $10 to $45 OR 20%....no explanation on that either.

The R5826-074 lists diagnostic tests and procedures as $0 to $290 copay. No mention of possibly paying 20%. X-rays $0 to $290 copay. No mention of possibly paying 20% on that either.

Humana should do a better job of listing what qualifies for each option on the new LPPO plan.

I have a couple that has Humana that did convert over the phone. Otherwise I've taken care of the rest, so far. People don't like answering the phone.

The 074 RPPO plan is non-commissionable next year so Humana clearly wants to convert everyone.

I've taken a proactive approach and am doing all of the conversions unless I can't reach someone. One of my clients had already done the phone route before I called him and said it took one hour and then Humana had to send him a paper application to sign and return-when he received the envelope (after I had made the switch electronically) it was empty so I have no clue how they are doing this.

I also called Humana and asked how I could track which clients have converted and was told to check my Delegated Members report (or something like that) that shows all enrollments with an effective date. I don't see any that have done a phone switch, have you been able to track your phone enrollments?

 

[wehotex]

I have heard stories of PDP members who called in about a question, and were tranfered to telesales that pitched an hmo/ppo. It was discussed on the forum last year during AEP, and a few agents said thats why they wont use humana pdp when they could use another carrier like silverscript.

As for the $10 giftcards, I really would like to know how that is within the rules. Last year I remember seeing Aetna offer $10 giftcards if a person shows up to a seminar. If its within the CMS rules, thats fine with me, I'd just like to know how I can use the Giftcard offer in my own marketing efforts.

A CMS spokeshole wrote to me that the $10 gift card is legal. It cannot be one where the person buys a stick of gum for 50 cents and then receives $9.50 cash money in change. That's what they mean when they say, not easily converted into cash. In the legit event that they let you buy the 50 cents gum, you would have $9.50 of credit to use in the store again to buy other items. Good news though is that the Agent can do this too just the way that they do it.

 

[I. M. Green]

Problem is, the new LPPO lists diagnostic tests and procedures as $0 to $200 OR 20%, with not an explanation as to what qualifies for each option. Outpatient X-rays as $10 to $45 OR 20%....no explanation on that either.

The R5826-074 lists diagnostic tests and procedures as $0 to $290 copay. No mention of possibly paying 20%. X-rays $0 to $290 copay. No mention of possibly paying 20% on that either.

Humana should do a better job of listing what qualifies for each option on the new LPPO plan.

I have a couple that has Humana that did convert over the phone. Otherwise I've taken care of the rest, so far. People don't like answering the phone.

Russ,

Depends on which diagnostic test is performed and where the test is performed.

-Diagnostic testing done at the hospital is usually much more expensive co-insurance, -applied after deductible.

-Same procedure at an outpatient facility/medical center will usually trigger the fixed copay, usually after the deductible is satisfied.

-Some diagnostic tests are cheaper than others, covered for $0 at an outpatient facility

That is at least how it was covered in previous years, they may have changed it, either way, an explanation must be given in the summary of benefits, it has to be spelled out.

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A CMS spokeshole wrote to me that the $10 gift card is legal. It cannot be one where the person buys a stick of gum for 50 cents and then receives $9.50 cash money in change. That's what they mean when they say, not easily converted into cash. In the legit event that they let you buy the 50 cents gum, you would have $9.50 of credit to use in the store again to buy other items. Good news though is that the Agent can do this too just the way that they do it.

I remember CMS strictly prohibits this practice. 100% on my AHIP and they ask that question 5 different ways. You can pull up documents regarding market rules where it says 'no gift cards', and it specifically states Health Plans and thier marketing representatives, A.K.A., agents. Posting from my iphone and it won't allow me to add attachments unfortunately.

 

[Chazm]

The 074 RPPO plan is non-commissionable next year so Humana clearly wants to convert everyone.

I've taken a proactive approach and am doing all of the conversions unless I can't reach someone. One of my clients had already done the phone route before I called him and said it took one hour and then Humana had to send him a paper application to sign and return-when he received the envelope (after I had made the switch electronically) it was empty so I have no clue how they are doing this.

I also called Humana and asked how I could track which clients have converted and was told to check my Delegated Members report (or something like that) that shows all enrollments with an effective date. I don't see any that have done a phone switch, have you been able to track your phone enrollments?

If he was sent a paper app it's because it was done prior to 10/15

 

[FLM2]

If he was sent a paper app it's because it was done prior to 10/15

That's probably it, thanks for the clarification.

 

[DeadSlash]

Russ,

Depends on which diagnostic test is performed and where the test is performed.

-Diagnostic testing done at the hospital is usually much more expensive co-insurance, -applied after deductible.

-Same procedure at an outpatient facility/medical center will usually trigger the fixed copay, usually after the deductible is satisfied.

-Some diagnostic tests are cheaper than others, covered for $0 at an outpatient facility

That is at least how it was covered in previous years, they may have changed it, either way, an explanation must be given in the summary of benefits, it has to be spelled out.

----------



I remember CMS strictly prohibits this practice. 100% on my AHIP and they ask that question 5 different ways. You can pull up documents regarding market rules where it says 'no gift cards', and it specifically states Health Plans and thier marketing representatives, A.K.A., agents. Posting from my iphone and it won't allow me to add attachments unfortunately.

You are correct.
I wonder how Humana is getting around it? It has to be a loophole, but I don't know what it is. I feel like everyone getting the g/c regardless of signing up for a plan or not is probably a key factor.

 

[wehotex]

Russ,

Depends on which diagnostic test is performed and where the test is performed.

-Diagnostic testing done at the hospital is usually much more expensive co-insurance, -applied after deductible.

-Same procedure at an outpatient facility/medical center will usually trigger the fixed copay, usually after the deductible is satisfied.

-Some diagnostic tests are cheaper than others, covered for $0 at an outpatient facility

That is at least how it was covered in previous years, they may have changed it, either way, an explanation must be given in the summary of benefits, it has to be spelled out.

----------



I remember CMS strictly prohibits this practice. 100% on my AHIP and they ask that question 5 different ways. You can pull up documents regarding market rules where it says 'no gift cards', and it specifically states Health Plans and thier marketing representatives, A.K.A., agents. Posting from my iphone and it won't allow me to add attachments unfortunately.

I e-mailed this question directly to a CMS spokeshole. His answer was that it was up to the "carrier" to regulate this. CMS could care less what agents do. You should see the crap that UHC agents get away with in San Antonio. The "gift" must be offered to everyone and cannot be "easily convertible into cash"

 

[Cenla Agent]

They're trying to reduce costs by skimping on marketing materials. The enrollment kits now are terrible- not even abbreviated formularies are available for potential clients to peruse through. Summary of Benefits has been reduced to just a few pages, lacking a lot of the details of the benefits/ member's responsibility. And Humana is stubborn about this new approach they have taken. It's like Nancy Pelosi is running the Humana Marketing team: "you have to join it to find out what's in it".
Also, Humana steadfastly refuses to send me a provider directory, whether for my own use or to distribute to my clients. They claim printed directories are outdated and that everyone should use the provider search tool. Probably 40% of my clients are over age 80 and most do not use or even have a computer. Humana sends a very "abridged" provider directory to members once enrolled. An abridged provider directory is not sufficient for a plan where members are "locked-in". Humana expects members to stay in network and would quickly deny charges received out of network, but they refuse to offer provider directories. At the very least, upon request members should be able to receive a printed directory. One of my clients today told me she argued with a customer service rep recently about this and she finally gave up and her request was denied. Comprehensive formularies and provider directories are essential tools for members and not having adequate access to them can result in unexpected out of pocket costs. I feel like having a few members filing grievances with Humana would get their attention and that's what I plan to do. I know that Humana is feeling the pain as a result of being one of the larger participants in the ACA marketplace, and so it seems they're cutting back on their overhead any way they can, especially with the MAPD. Is it unreasonable to expect these materials be available in printed format, especially upon request. Obviously, not everyone has access to a computer. What say you?

BCBS doesn't provide that info to people either, at least not until they enroll.

Maybe Humana took some of that $$ and put it toward their massive ANOC book instead.

I think Peoples Health will still send a provider directory to prospective members.

 

[FLM2]

I'm disgusted for a different reason with Humana-they are allowing other agents to poach my clients by enrolling them in the new PPO.

Basically, any agent who contacts a 074 plan holder and does a new enrollment gets the member and we are screwed regardless of how long that person has been our client. It's already happened at least 1X to me.

Thanks Humana for protecting your 'valued' agents once again...

 

[Chazm]

I'm disgusted for a different reason with Humana-they are allowing other agents to poach my clients by enrolling them in the new PPO.

Basically, any agent who contacts a 074 plan holder and does a new enrollment gets the member and we are screwed regardless of how long that person has been our client. It's already happened at least 1X to me.

Thanks Humana for protecting your 'value' agents once again...

according to humana if they switch over the phone you are AOR. Now if they strand a meeting and sign up you will lose them or if another agent comes out to talk to them you can lose them. But if your client switched over the phone you are ok