HUMANA PFFS MA-only Plan Feedback

[Rossat]

Any agents selling the premium based, low MOOP, Humana PFFS MA-Only plan?

If so, any feedback?

I'm in a state where Humana's network isn't the best, but not terrible. I have a hard time with the whole "no-network" aspect. Not because I don't understand the plan, but because I don't believe doctor's office staff understand the concept of PFFS and will just say "we don't take it".

 

[DonP]

Any agents selling the premium based, low MOOP, Humana PFFS MA-Only plan?

If so, any feedback?

I'm in a state where Humana's network isn't the best, but not terrible. I have a hard time with the whole "no-network" aspect. Not because I don't understand the plan, but because I don't believe doctor's office staff understand the concept of PFFS and will just say "we don't take it".

I wouldn't sell it . Just ask yourself a question . The product replaced other products and has even better benefits . Humana's under intense final pressure . It's because it's financially more profitable to them . A dr must agree to Humana's payment terms . Drs can balance bill I read . So it's very possible your client can get an extra bill from the dr or hospital

 

[Rossat]

I wouldn't sell it . Just ask yourself a question . The product replaced other products and has even better benefits . Humana's under intense final pressure . It's because it's financially more profitable to them . A dr must agree to Humana's payment terms . Drs can balance bill I read . So it's very possible your client can get an extra bill from the dr or hospital

Appreciate the insight. Its an enticing plan in our area/state. I'm questionable with Humana personally. Somethings just seem to good to be true.

 

[sman]

I wouldn't sell it . Just ask yourself a question . The product replaced other products and has even better benefits . Humana's under intense final pressure . It's because it's financially more profitable to them . A dr must agree to Humana's payment terms . Drs can balance bill I read . So it's very possible your client can get an extra bill from the dr or hospital

Where'd you read that? I can tell somebody has done no research on the Humana PFFS plan. Directly from their Evidence of Coverage:

Balance billing is when providers, such as doctors or hospitals, charge and bill patients up to 15% more than the plan's payment amount for services. The balance billing amount is collected in addition to the patient's regular plan cost-sharing amount. Humana Gold Choice H8145-069 (PFFS) does not allow providers who provide plan-covered services to balance bill members of our plan. (For more information, see Section 1.3 of this chapter.)
Furthermore, the Humana PFFS plan actually has a network. You can look doctors up online quite easily. And just like in a PPO, if you want to see an out of network provider, they have to be willing to accept the terms and payment of the plan.

Additionally, something very unique to the PFFS plan, directly from the EOC:

Humana Gold Choice H8145-069 (PFFS) does not require members or their providers to obtain prior authorization or a referral from the plan as a condition for covering medically necessary services that are covered by our plan.

 

[DonP]

Where'd you read that? I can tell somebody has done no research on the Humana PFFS plan. Directly from their Evidence of Coverage:

Balance billing is when providers, such as doctors or hospitals, charge and bill patients up to 15% more than the plan's payment amount for services. The balance billing amount is collected in addition to the patient's regular plan cost-sharing amount. Humana Gold Choice H8145-069 (PFFS) does not allow providers who provide plan-covered services to balance bill members of our plan. (For more information, see Section 1.3 of this chapter.)
Furthermore, the Humana PFFS plan actually has a network. You can look doctors up online quite easily. And just like in a PPO, if you want to see an out of network provider, they have to be willing to accept the terms and payment of the plan.

Additionally, something very unique to the PFFS plan, directly from the EOC:

Humana Gold Choice H8145-069 (PFFS) does not require members or their providers to obtain prior authorization or a referral from the plan as a condition for covering medically necessary services that are covered by our plan.

I havent specifically looked at Humana's . But when I investigated pffs I got they can balance bill . So what's the catch then ? Much better benefits than plans Humana pulled that were losing money . Network must be terrible as this product negotiates lower reimbursement the provider must accept

 

[sman]

I havent specifically looked at Humana's . But when I investigated pffs I got they can balance bill . So what's the catch then ? Much better benefits than plans Humana pulled that were losing money . Network must be terrible as this product negotiates lower reimbursement the provider must accept

You should definitely keep making decisions on a google search of generic PFFS and not read Humana's specific plan information. That's definitely the best way to go.

As for their network, maybe look it up. Just the Fulton-Dekalb PFFS directory is 492 pages. But sure, just go on the assumption that the network must be terrible without even looking it up.

 

[grod]

Any agents selling the premium based, low MOOP, Humana PFFS MA-Only plan?

If so, any feedback?

I'm in a state where Humana's network isn't the best, but not terrible. I have a hard time with the whole "no-network" aspect. Not because I don't understand the plan, but because I don't believe doctor's office staff understand the concept of PFFS and will just say "we don't take it".

I wrote the UHC version of that plan 10 plus years ago until they made it non commissionable. I always called the doctors office to make sure they accepted it. I never had any trouble with it. UHC eventlually replaced it with the RPPO and pulled the PFFS off the market altogether.

 

[sman]

I wrote the UHC version of that plan 10 plus years ago until they made it non commissionable. I always called the doctors office to make sure they accepted it. I never had any trouble with it. UHC eventlually replaced it with the RPPO and pulled the PFFS off the market altogether.

Not quite the same. The Humana PFFS has a network and also doesn't allow balance billing. Old PFFS plans had no network and allowed balance billing. The main reason I didn't sell the old PFFS plans is because of the network issue. I don't have time to call a bunch of doctor's offices to confirm if they will take a plan. On top of that, 6 months later they could tell the patient they no longer accept it and then your client is pissed at you for saying they did.

I prefer plans with networks.

 

[DonP]

Not quite the same. The Humana PFFS has a network and also doesn't allow balance billing. Old PFFS plans had no network and allowed balance billing. The main reason I didn't sell the old PFFS plans is because of the network issue. I don't have time to call a bunch of doctor's offices to confirm if they will take a plan. On top of that, 6 months later they could tell the patient they no longer accept it and then your client is pissed at you for saying they did.

I prefer plans with networks.

Ok since you checked it out . How's the network vs the ppo or hmo plans ?Basically all the same dr's in network ?I looked at the plan . Again i ask a very simple question . Humana sure as hell didn't come up with a plan with $0 at regular dr/$20 specialist , $2500 full dental, $250 a qtr otc and $300 glasses with no catch to it . They didn't do it out of the goodness of their heart .They termed many areas and products with much less benefits . Where's the downside ?

 

[sman]

Ok since you checked it out . How's the network vs the ppo or hmo plans ?Basically all the same dr's in network ?I looked at the plan . Again i ask a very simple question . Humana sure as hell didn't come up with a plan with $0 at regular dr/$20 specialist , $2500 full dental, $250 a qtr otc and $300 glasses with no catch to it . They didn't do it out of the goodness of their heart .They termed many areas and products with much less benefits . Where's the downside ?

I'm not going to do your work for you. It's not hard to look at the network. You can download pdf's of their directories. I doubt the networks are identical, but for the ones I've enrolled, all of their doctors have been in the PFFS network. You can look them up online as well. It really isn't that difficult.

As far as the reimbursement rate goes, I couldn't care less if the doctor is in network. They've agreed to the amount so it makes no difference to me or the client.

Nobody is asking you to sell it. I was correcting the misinformation you posted.