PDP Trial Right

[somarco]

Not sure why everyone is concerned about trial rights and SEPs, etc, etc. File a complaint with Medicare (I would use their online form) and clearly state that the MAPD enrollment was fraudulent and should be cancelled as if never enrolled and that the PDP should be reinstated effective XX date (without lapse). It's not that hard!

PDP carrier discussed Trial Right with the daughter before I was involved . . . got a late invitation to the party . . . only arrived late yesterday afternoon after daughter found me on YT.

I agree the Medicare fraud complaint is the best route, and I have suggested such, as long as the process does not drag out too long

 

[TwoCents]

PDP carrier discussed Trial Right with the daughter before I was involved . . . got a late invitation to the party . . . only arrived late yesterday afternoon after daughter found me on YT.

I agree the Medicare fraud complaint is the best route, and I have suggested such, as long as the process does not drag out too long

For non-critical complaints (usually those involving access to meds/care, plans have up to 30 days to respond.

 

[KandKsmommy]

I had this happen with two of my patients at a local hospital prior to becoming an agent. Both where non-verbal with sever intellectual disabilities. Their brother was their POA and I suggested that he go to their apartment and look for a business card. Sure enough the agent had left one and I helped him file a formal complaint and the agent from what I heard lost her license.
While the calls are recorded I have been on a few of the calls back when we had a new carrier offering a DSNP that didn't accept Medicare.gov apps (I was a SHIP) the way they go over things and how it is worded leaves many completely confused and unaware of what they are agreeing to. They just say yes because that is what they are coached to do prior to the recording starting.

 

[somarco]

I had this happen with two of my patients at a local hospital prior to becoming an agent. Both where non-verbal with sever intellectual disabilities. Their brother was their POA and I suggested that he go to their apartment and look for a business card. Sure enough the agent had left one and I helped him file a formal complaint and the agent from what I heard lost her license.

While the calls are recorded I have been on a few of the calls back when we had a new carrier offering a DSNP that didn't accept Medicare.gov apps (I was a SHIP) the way they go over things and how it is worded leaves many completely confused and unaware of what they are agreeing to. They just say yes because that is what they are coached to do prior to the recording starting.

This confirms my suspicion that many of the presentations (phone or F2F) are abbreviated and do not comply with MCMG rules. Rather they are simply offered in such a way as to complete the sales process as quickly as possible and move on to the next fish.

Not everyone over 65 experiences diminished capacity but as we (they) age cognitive impairment to some degree is to be expected. What may or may not have been understood at age 65 is almost certain to have lesser comprehension at 70, 75 and beyond.

 

[KandKsmommy]

The presentation focus on the benefits and rarely mention the actual costs in detail. I get we are in sales but as a broker I feel like my clients best interest comes before my pocket. Unfortunately it seems like many of these phone and even some F2F agents put their pockets first. We have a local agent flipping very sickly Med Supp clients to MAPD under the $0 premium and lower costs marketing. Theres no mention of how much people can expect to pay, the need for prior auths and networks, or the fact that they can be denied a med supp outside of GI rights. It works out for me though because after a bad experience with them they end up at my office.

 

[somarco]

The presentation focus on the benefits and rarely mention the actual costs in detail. I get we are in sales but as a broker I feel like my clients best interest comes before my pocket. Unfortunately it seems like many of these phone and even some F2F agents put their pockets first. We have a local agent flipping very sickly Med Supp clients to MAPD under the $0 premium and lower costs marketing. Theres no mention of how much people can expect to pay, the need for prior auths and networks, or the fact that they can be denied a med supp outside of GI rights. It works out for me though because after a bad experience with them they end up at my office.

I lost a new T65 Medigap client last year to a MAPD peddler. Client was facing 2x knee replacement, one late last year (2021) and another early this year. She said the premium was kind of a stretch for her but appreciated the $203 & $233 OOP cap. She asked about the no premium plans so I helped her understand some things agents never mentioned.

One was the lack of providers in her rural area and the probability of having to travel 150 miles or so to a par hospital for the surgery.

The other concern was her OOP for 2 surgeries in 2 different calendar years.

She had the policy for a month before canceling. I usually don't follow up with cancellations but broke my rule on this one. Yes, she did intentionally cancel the policy and did enroll in a no premium plan. I reminded her of our discussion about OOP costs . . . she responded by saying her OOP with the MAPD would be about the same plus there was no premium to pay.

She was a lifetime 2 pack per day smoker on multiple BP med's and I suspect failed to comprehend what she had and what she was getting in exchange.

 

[kgmom219]

If you have someone with dementia that has a POA and does this, the POA calls Medicare and gets it fixed. No problem at all, as long as you are within the 30 day window. The trick is not to just say "I have a POA" they need to include "dementia diagnosis" when talking to the rep

 

[somarco]

regional hospital system's Medicare Select, where they have a supp $50 cheaper with no underwriting.

FYI, I don't know where you are, or how long this offering has been in place, but providers have a discouraging success rate with these ventures. They seem to play out better in rural area where there are fewer provider choices and the sponsoring hospital has acute care facilities and a "captive" audience.

Providers are not in the risk managemen/abatement business and quite often find profits marginalized due to non-paying patients . . . those who are insured but can't/won't pay the OOP balance.

Lower premium and no underwriting waves a red flag at me.

MAPD plans essentially do the same thing but also have a managed care iron fist to hold down claims.

 

[sman]

I lost a new T65 Medigap client last year to a MAPD peddler. Client was facing 2x knee replacement, one late last year (2021) and another early this year. She said the premium was kind of a stretch for her but appreciated the $203 & $233 OOP cap. She asked about the no premium plans so I helped her understand some things agents never mentioned.

One was the lack of providers in her rural area and the probability of having to travel 150 miles or so to a par hospital for the surgery.

The other concern was her OOP for 2 surgeries in 2 different calendar years.

She had the policy for a month before canceling. I usually don't follow up with cancellations but broke my rule on this one. Yes, she did intentionally cancel the policy and did enroll in a no premium plan. I reminded her of our discussion about OOP costs . . . she responded by saying her OOP with the MAPD would be about the same plus there was no premium to pay.

She was a lifetime 2 pack per day smoker on multiple BP med's and I suspect failed to comprehend what she had and what she was getting in exchange.

Two outpatient surgeries likely wouldn't break the bank. But if she went to physical therapy multiple times per week for multiple weeks, she would have liked a Med Supp over the MAPD.

 

[somarco]

Two outpatient surgeries likely wouldn't break the bank. But if she went to physical therapy multiple times per week for multiple weeks, she would have liked a Med Supp over the MAPD.

My perspective was/is, if she had the surgeries 3 months apart over 2 calendar years the surgeries + PT, etc would likely exceed the Medigap premiums + OOP during that time frame . . . plus the inconvenience of long distance travel to access par providers.