Then again you did mention lapse? Did they not attempt to pay his portion of the Supplement? If they did I would think they would of knew of the potential pitfall they now find themselves in.
Pyramid refunded her premium in feb. from what the client told me. They were on PAC. That is to protect clients from lapse due to non payment. I don't know why it said lapse on the E.O.B.
Kyle you are right. The thing that puzzles me is that Pyramid doesn't have supp policies, at least not in Missouri. The supp policies are written through American Pioneer. My agent number with Am Pi is the same as it is with Pyramid.
Am Pi does not have one policy for both husband and wife. Although, the agent can write one app that includes both of them but they get separate policies. By putting them both on the same app they get a 5% discount.
If it has been less than 60 days since he policy lapsed they can get it reinstated by sending a letter to Am Pi. More than 60 days a new app is required.
The problem most likely occurred if she went to the bank to cancel her automatic bank draft and told the bank to cancel all payments to Am Pi. There is a huge danger in the agent calling the company and cancelling. Also, in addition to the agent asking that a policy be cancelled Am Pi requires a written statement from the policy holder. I always assist them with that statement especially if both husband and wife have their supps with the same company and only one of the two are cancelling.
Regardless of why it all happened if it is within 60 days call Am Pi and then have the client send a letter requesting reinstatement.
If Pyramid sells supps and I am not aware of it then all the above info may be worthless.
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I dont believe pyramid sells supps anymore. They did last year though. They stopped selling because they were way outta the market and not making money on them.
There is an example where it would have been a lot better to let people think I didn't know anything about the thread, than to open my mouth and remove all doubt.
I still have never seen an app from a supp company that issues only one policy for both husband and wife. Also that they don't give the policy holder a reasonable amount of time to reinstate the policy. Lapses can happen for all kinds of reasons.
That also is a new one to me. Thanks, I learned a lot from that thread.
The wife called in and cancelled her policy. The cancellation date was
2-1-07. I signed him up for MA on 3-22-07, effective 4-1-07.
Then you did not cancel the policy and are therefore off the hook as far as that goes. It sounds like the facts are a little unclear on this really. But, I do not think you have anything to worry about as long as you have not touched their supplements yourself nor encouraged either of them to lapse their supps without applying for other coverage--which according to you, you didn't.
As Frank said, he should be able to reinstate. But, do not count on him getting back in after 60 days even if he is trying out the MA plan for 2 months. An MA plan does not guarantee a new open enrollment or guarantee issue...the law just states that seniors can leave a supplement to try an MA plan and within 12 months can go back to the same supplement and carrier they previously had if it is available.
With all the companies I represent they can get all claims paid when reinstated if they also pay the premiums for those months and usually the current premium as well as the next months premium.
At least in the cases where I have had that happen that is how it was handled.
I'm talking about the lapse of a med supp policy for 60 days or less. Not getting their med supp policy after having been on an Advantage plan for several months.
Last edited by Frank Stastny : 03-23-2007 at 11:39 PM.
Yes. He had the surgery, He hasnt even got the EOB yet from medicare. They way they found out he was cancelled was he had a dr. visit feb. 17 and in The EOB (explanation of benefits) it said no payment due to lapsed policy. I called pyramid and they said it lapsed because the wife cancelled her policy. I have never ran into this with medicare supplement policies.
I have never heard of a "dependent" with med supps either. Maybe when she cancelled it messed up something with his bank draft? Often companies will draft the policies in one lump sum for husband and wife, sometimes including LTC or other products as well.
Since he enrolled in MA after 1/1 he already used his OEP for 2007 and will not be able to make any changes to his coverage for 2007 unless he moves to a new service area. His next option to change plans will be the 2008 AEP beginning 11/15/07 for a 1/1/08 effective date.
From this point forward, only contact these people via e-mail or some form of verifiable contact. This will eliminate the "he said/they said" situation, should this get sticky.
Secondly, contact an attorney, whether it be PrePaid Legal or otherwise. When it comes right down to it, these people care more about not paying then looking out for you.
Thirdly, get trained. Contact an FMO or GA who is willing to train you properly on these products before sending you out. You did nothing wrong, and you were not malicious in your intent. If there is noone willing to do that, call MA provider 100+ times a day, asking questions, playing the "what if" game.
Lastly, dont let this consume you. Use it as a learning experience. Move on. Call on other people. Don't let your confidence get shaken.
From this point forward, only contact these people via e-mail or some form of verifiable contact. This will eliminate the "he said/they said" situation, should this get sticky.
Secondly, contact an attorney, whether it be PrePaid Legal or otherwise. When it comes right down to it, these people care more about not paying then looking out for you.
Thirdly, get trained. Contact an FMO or GA who is willing to train you properly on these products before sending you out. You did nothing wrong, and you were not malicious in your intent. If there is noone willing to do that, call MA provider 100+ times a day, asking questions, playing the "what if" game.
Lastly, dont let this consume you. Use it as a learning experience. Move on. Call on other people. Don't let your confidence get shaken.
Good advice. Often what we think is going to destroy us is really just a good learning experience.
Hey Buddy ... have you looked into helping them apply for Charity Care ? did you see if they qualify for Medicaid ? Charity Care info can be found at thier local hospital ... worse comes to worse contact you local Catholic Church and ask them for help. Good luck.
Why not explain what was wrong about her statement rather than say this.
Your right, I'm sorry Cenla. When you said he won't be able to change, that is not the case. The first time you sign up for an advantage plan, you can change anytime within the first 12 months. Sorry i was grouchy when i posted last.
No I have not looked into charity yet. They have not got thier bill for the surgery. It might be minor.. I dont know what it is goona cost. Hopefully pyramid is gonna pay it. I feel like they should. WHich doesn't matter I know.
Your right, I'm sorry Cenla. When you said he won't be able to change, that is not the case. The first time you sign up for an advantage plan, you can change anytime within the first 12 months. Sorry i was grouchy when i posted last.
Let's clarify, you can't change anytime in the first 12 months, but you can revert to your prior coverage,regular medicare and a pdp or medicare, a medsup and a stand alone pdp, that is my understanding.
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