Insurance Agent Forum

[insurance0707]

In all of our training and certifications it stated that you can only be enrolled in one Prescription drug plan at a time. If you enroll someone in a PDP plan that had a MAPD plan, it's going to automatically disenroll them from the MAPD plan. Of course, I'm getting calls from clients that the MAPD plan took out premiums from their accounts. I know you can send in a disenrollment form that would disenroll them from the MAPD but it's kind of nerve racking to do that because sometimes the PDP plans don't get issued or they get lost at the home office, then the client has nothing.

Are any of you having this problem? What's the best way to get them disenrolled.

[Russ]

Originally Posted by insurance0707

In all of our training and certifications it stated that you can only be enrolled in one Prescription drug plan at a time. If you enroll someone in a PDP plan that had a MAPD plan, it's going to automatically disenroll them from the MAPD plan. Of course, I'm getting calls from clients that the MAPD plan took out premiums from their accounts. I know you can send in a disenrollment form that would disenroll them from the MAPD but it's kind of nerve racking to do that because sometimes the PDP plans don't get issued or they get lost at the home office, then the client has nothing.

Are any of you having this problem? What's the best way to get them disenrolled.

Heck...I've sent a few letters to one carrier to get someone dis-enrolled last year(2008 season)....it was Today's Options. It was nothing but aggravating to the person and me. I got them back on Medicare and a Medicare Supplement. Company was feeding this lady a line of BS. I don't trust the companies when it comes to dis-enrolling someone.

[walleyeb1]

As you stated this should disenroll them. But, it doesn't mean that the old company gets things done timely. I always advise clients to stop the auto bankdraft. If they don't the outcome is as you described. It will probably get straightened out but will take some phone calls and more headaches.

[insurance0707]

I did send in a disenrollment form for one client. It took 2 months before they stopped deducting the premium. This was with a disenrollment form and a new PDP plan in place.

[MedicarePlanSolutions]

Originally Posted by insurance0707

In all of our training and certifications it stated that you can only be enrolled in one Prescription drug plan at a time. If you enroll someone in a PDP plan that had a MAPD plan, it's going to automatically disenroll them from the MAPD plan. Of course, I'm getting calls from clients that the MAPD plan took out premiums from their accounts. I know you can send in a disenrollment form that would disenroll them from the MAPD but it's kind of nerve racking to do that because sometimes the PDP plans don't get issued or they get lost at the home office, then the client has nothing.

Are any of you having this problem? What's the best way to get them disenrolled.

When someone enrolls in an MAPD (or MA for that matter) the plan sends that message to CMS who then process it and then kicks it back. The next time the old PDP get's an update it will tell them the member left their plan and then they have to process that internally. The lag time from when the app gets submitted to when the old plan cancels it from their end can be quite long. The best thing to do would be to have the member call the old plan (or call them with you) and have them disenroll that way. Another option would be to have them change the method of payment and then just have them not send in the check. The old plan should have received the disenroll notice before the second bill gets sent.

I have a customer new to Medicare and signed for a Secure Horizons mapd. He changed his mind a month later and we called to have him dissenrolled so I could get him a med sup instead.
The mapd co. never did the dissenrollment and he also had the med. sup. active and was paying for it.
He then has surgery 3 months later only to have all ins. denied for claims pay because the hospital was not on the list for the mapd and wont file claims, the med sup wont pay since he has an mapd still in force.
Can we come to the conclusion that medicare nor the advantage plan companies play by any set of rules? This is rediculous. He is now threatening to sue me for not representing things truthfully. Any advise on this one?
Ugh

[stormtracker]

What is your E&O deductible?

[AgentOrange]

I would advise you to put everything in your moms name. Lock in is lock in, did you explain election periods and lock in ? There isnt a 30 day free look with mapds.

[jdeasy]

Originally Posted by AgentOrange

I would advise you to put everything in your moms name. Lock in is lock in, did you explain election periods and lock in ? There isnt a 30 day free look with mapds.

No, but he said the client was new to Medicare. If this disenrollment was during the 7 month window, it was legal and should have been honored.

[AgentOrange]

Jdeasy, you know too many crazy election period rules. code sep-trial.

[retread]

Originally Posted by insurance0707

In all of our training and certifications it stated that you can only be enrolled in one Prescription drug plan at a time. If you enroll someone in a PDP plan that had a MAPD plan, it's going to automatically disenroll them from the MAPD plan. Of course, I'm getting calls from clients that the MAPD plan took out premiums from their accounts. I know you can send in a disenrollment form that would disenroll them from the MAPD but it's kind of nerve racking to do that because sometimes the PDP plans don't get issued or they get lost at the home office, then the client has nothing.

Are any of you having this problem? What's the best way to get them disenrolled.

Medicare's computer system will automatically disenroll a former MA and/or PDP whenever a newer dated one is entered. This is important, because a new PDP can auto disenroll a MAPD, leaving the client with Original Medicare (along with the new PDP). Neither you nor the client need do anything to effect disenrollment of a MA/MAPD/PDP plan when another is applied for.

Premium payment is another matter. How were the clients paying their former plan? If it is EFT, then they need to call the plan and ask them to stop deductions. Most of my clients have had success with a phone call. If the carrier demands the request in writing, have a pre-printed stop request available to hand your client. It is going to have to be delivered to the old carrier before the last day of the month prior to the next deduction. You may need to fax it.

For Med Sups, I provide the client with a pre-addressed cancellation request. I have them sign it and send it in when they get the new carrier's "welcome" letter. Here is the rub... if the new carrier doesn't process the paperwork until after the end of the month, the client is exposed to another month's premium from the old carrier. When they complain about this, I tell them if they cancel their Med Sup before getting confirmation of acceptance to the new plan, they are in danger of having no insurance if something screws up. However, with Coventry's App Tracker, I some times can tell them the date their application was entered into the system and whether they are in "pre-enrollment" or "active" status. This gives them more information to decide if they want to chance it or not.

In all cases, any EFT is going to (at a minimum) require the client to call the carrier to get the deductions stopped. Everyone should know this. Did you sleep during this part of certification?

If the client is paying by coupon, not a problem... just stop paying.

SSA deductions are a bummer. I always warn people how difficult it will be to get a refund from Uncle Sam.

[MedicarePlanSolutions]

Originally Posted by Call4Insurance

I have a customer new to Medicare and signed for a Secure Horizons mapd. He changed his mind a month later and we called to have him dissenrolled so I could get him a med sup instead.
The mapd co. never did the dissenrollment and he also had the med. sup. active and was paying for it.
He then has surgery 3 months later only to have all ins. denied for claims pay because the hospital was not on the list for the mapd and wont file claims, the med sup wont pay since he has an mapd still in force.
Can we come to the conclusion that medicare nor the advantage plan companies play by any set of rules? This is rediculous. He is now threatening to sue me for not representing things truthfully. Any advise on this one?
Ugh

Did he change his mind before the effective date? Either way, plans ROUTINELY process things incorrectly and calling 1-800 Medicare to complain about it usually helps. Not that you wont have to call 3 times to get someone who knows what they're doing, but they can override that if the plan messed up.

On an interesting aside, I had a major carrier process an app TOTALLY wrong and Medicare had to fix it. I enrolled a lady in an MA only because she liked her PDP and then the carrier enrolled her in their MAPD. I thought that *maybe* I had made a mistake, went and took a look at the app, and plain as anything I had marked the MA only option. Moral of the story, plans really can make major mistakes and the agent can get stuck in the middle of it.

[jdeasy]

Originally Posted by MedicarePlanSolutions

Did he change his mind before the effective date? Either way, plans ROUTINELY process things incorrectly and calling 1-800 Medicare to complain about it usually helps. Not that you wont have to call 3 times to get someone who knows what they're doing, but they can override that if the plan messed up.

On an interesting aside, I had a major carrier process an app TOTALLY wrong and Medicare had to fix it. I enrolled a lady in an MA only because she liked her PDP and then the carrier enrolled her in their MAPD. I thought that *maybe* I had made a mistake, went and took a look at the app, and plain as anything I had marked the MA only option. Moral of the story, plans really can make major mistakes and the agent can get stuck in the middle of it.

Eliminating lock in would make those mistakes easily fixable.

[Russ]

Originally Posted by Call4Insurance

I have a customer new to Medicare and signed for a Secure Horizons mapd. He changed his mind a month later and we called to have him dissenrolled so I could get him a med sup instead.
The mapd co. never did the dissenrollment and he also had the med. sup. active and was paying for it.
He then has surgery 3 months later only to have all ins. denied for claims pay because the hospital was not on the list for the mapd and wont file claims, the med sup wont pay since he has an mapd still in force.
Can we come to the conclusion that medicare nor the advantage plan companies play by any set of rules? This is rediculous. He is now threatening to sue me for not representing things truthfully. Any advise on this one?
Ugh

I feel for you and hope it works out.

I'm soooo glad I've never, to this day, written a single MA plan. What a headache....just like the months long headache to get a client I have, off of a MA plan that kept drafting for several months after we had mailed or faxed in several cancellation letters.

[honestagent]

This is not 'unusual' as it takes time for all systems to sync sometimes being as long as up to 3 to 4 months!


Yes you read that correctly 3 to 4 months. If I'm reading this right, the client enrolled into another prescription plan and the old plan is still deducting. Is that correct?

If I read that right, then the client needs to call Medicare and resolve it with them. And track track track each month till all funds are re-instated either in the draft or through Social Security.

I went through this with several clients in 06 when they took the prems. from their Social Security and what a MESS.... it took almost 5 months to resolve. Bottom line: Direct Coupon is the best route for future bz. should you plan to stay in this game. That gives the clients the control to dictate funding!

For now, have them call Medicare and the old and current carriers and keep logs and see what perpetuates each month until all funds are again retroactively refunded. Eventually it will all work out.

Sidenote: of course this will only work assuming Medicare shows in their system that client is enrolled in the new plan. Confirm that first - before starting to call the carriers...even if the client has the 'letter' or new card with the new carrier. Good luck! IT SUCKS!

Originally Posted by insurance0707

In all of our training and certifications it stated that you can only be enrolled in one Prescription drug plan at a time. If you enroll someone in a PDP plan that had a MAPD plan, it's going to automatically disenroll them from the MAPD plan. Of course, I'm getting calls from clients that the MAPD plan took out premiums from their accounts. I know you can send in a disenrollment form that would disenroll them from the MAPD but it's kind of nerve racking to do that because sometimes the PDP plans don't get issued or they get lost at the home office, then the client has nothing.

Are any of you having this problem? What's the best way to get them disenrolled.

[MedicarePlanSolutions]

Originally Posted by jdeasy

Eliminating lock in would make those mistakes easily fixable.

Still back at that one, huh? That wouldn't really fix it because this is the carrier/Medicare/SS messing things up. That being said, universal healthcare would fix this issue AND could elmiinate lock-in!

[jdeasy]

Originally Posted by MedicarePlanSolutions

Still back at that one, huh? That wouldn't really fix it because this is the carrier/Medicare/SS messing things up. That being said, universal healthcare would fix this issue AND could elmiinate lock-in!

I never left it. But, I agree with you on the healthcare.