Never Trust a Home Office CSR

somarco

GA Medicare Expert
5000 Post Club
36,602
Atlanta
Got an email yesterday from a client. She had called Humana because she didn't want to bother me with something she considered trivial.

Currently has a Monogram, looking to save money.

Her email indicated she was frustrated, confused and angry that the CSR offered no help other than suggest an HSA plan that was about $80 less per month.

Higher deductible.

No Rx coverage.

I hit the ceiling.

I also fired off an email to the RSD giving details and asking what Humana's liability would be if this family later had a change in health that required medication.

No response yet.

My client will most likely keep what she has since changing to a family HSA, WITH Rx, will increase her premium, not cause it to drop.

This is not the first time this has happened, and Humana is not the only carrier guilty of this bullsheet.
 
What country is the CSR from? Costa Rica, India or unknown? Oh yeah, those CSRs are reserved for senior clients, especially the one with hearing problems who can't understand accents. That way Humana can say, I told your client this already (just not in English).

In this case you can re-emphasize to your client just how important you are to her in her insurance-related decision making.

Send this to your client:

how-to-fight-bad-customer-service: Personal Finance News from Yahoo! Finance
 
Last edited:
I complained to H over 6 months ago, and it went nowhere. At renewal, their "alternative" plan is very deceiving, and most don't catch the plan difference beyond the change in the deductible. Ex: 5000 HSA + Rx, alternative offered is $5200 HSA NO RX. Client savings is about $500/year. Any person without their head in their arsh would do the math and choose the alternative plan. I've had to reverse over 5 policies since the client didn't run it by me first. 1 could not be reversed, and it bit him when an illness needing Rx came within months of the change. Others, know about the removal of Rx coverage, and still change...."I don't use Rx now, and I don't forsee needing Rx...I am healthy". That's when I review the definition of "insurance". Idiots
 
Happens all the time with me. Client calls the carrier. CSR tells them something. They call me.
The most recent was one of my clients (age 57) that had a $2000 deductible, $45 ov copay, $10 generic copay, $35 Brand copay. This plan also had maternity.
The CSR told her, "If you deleted the maternity and changed to the $2500 HSA, you would save $83/month".
My client calls me steaming mad.
My client takes Advair (retail of $225/month).
I had to explain the that $83 in savings came from the +$500 add'l deduct & Ov's & Rx getting applied towards the deduct. For a 57 year old, the slope on the premium attributed to maternity is probably $.25/month.
 
As indicated, H1 is not the only culprit. We visited the issue of alternate offers at renewal at least 2 yrs ago at a broker council.

As you said, got nowhere.

In my lunch with the H1 RSD a few days ago I mentioned the sanitized apps generated for workbench that do not provide details on the "yes" answers to medical history.

He had no idea this was going on even though I had mentioned this to my rep 2 months ago.

As for the HO CSR switch from Rx to no Rx, I have experienced this with H1, GR, KP and Aetna.

So far, every time (except one) I have discovered the problem it can be reversed.

Had a lady a few years ago that was switched by KP to a lesser plan and "the only difference is, no maternity".

She was 62 at the time and saw no need to continue maternity, so she switched without my knowledge.

By the time I found out it was too late.

Yes, the new plan did not cover maternity but the premium for the old plan to include maternity was nothing.

The old plan covered lab as part of the OV copay, this one did not.

The old plan had unlimited benefits, this did not.

The old plan had a better Rx benefit, the new one covered Rx but with a higher ded and copay.
 
Well they all better get used to this type of service. Unless things change, this is the best they are gonna get come 2014.
 
I had another client that had a comprehensive $2500 deductible plan.
One day, he was on the telephone to Anthem and was lamenting about how high his premiums were. The CRS with Anthem told him about the "Basic Hospital" plan and how he could cut his monthly premium in half.
The "Basic Hospital" plan strips out ov's, rx's, lab, xray, etc.
Client makes the change directly with Anthem.
Several years go by. The clients daughter breaks her leg.
Walkin clinic charges, casting charges, xrays, physician visits, ongoing PT all not covered.
Client calls me pissed off.
First of all, I know nothing about the change he made directly w/Anthem.
None of my carriers notify me if any of my clients makes a coverage change. In fact, if my client makes an address change directly, I will never know.
The client complains that the lack of outpatient coverage wasn't fully explained to him.
HELLO! McFly! What part of the "Basic Hospital" plan don't you understand?
 
Well they all better get used to this type of service. Unless things change, this is the best they are gonna get come 2014.

Oh, I don't know. They will also have navigators to help them find a plan in the Exchange. Govt workers are much better trained and more caring that HO employees.

"Hey, this is Tameka. Watchu wan?"

I know nothing about the change he made directly w/Anthem.
None of my carriers notify me if any of my clients makes a coverage change. In fact, if my client makes an address change directly, I will never know.

You noticed that too, huh? It's almost like the HO feels like their policyholder is also their client.

What part of the "Basic Hospital" plan don't you understand?

I know you are not surprised because you get the same calls I do.

"All I need is a plan to cover me in case I go to the hospital".

My response is, "Do you plan on dying there? Because if you do, then a hospital plan is all you need. But if you are not leaving in a box then you need to find a way to pay for the follow up doc & Rx"
 
Bob, your just trying to earn a commission, all you salespeople are alike! I'll call the company directly, they offer much better rates if you don't involve a "middleman"!
 
Back
Top