Case Question................

[Tkruger]

I’m posting this here because it applies to Medicare recipients of both parts A and B.

I contact a lead today whose name is not grammatically gender specific. I reach the contact and learn in the first 60 seconds that this person is transitioning. The odd part is even with my questions I couldn't figure out which way. I believe however it's female to male.

Mentioned surgeries scheduled as I'm checking Dr. and meds.

Currently has just straight A and B with a D.

Carrier covered all Dr. aside from shrink, meds (27) all covered but 1 which was easily changed to something that would accomplish the same thing...I was about to complete the enrollment when that little voice in my head said stop.

During the entire 52 min conversation, this person is having a full-on conversation with their cat. Not a hey kitty kind of conversation, this was a full blown person talking asking questions and then said person responding in a cat voice....kinda.

There were 3 emotional (raised voice and crying) outburst during the initial plan review for various questions I was asking.

I handle every call the same. My voice inflection mirrors the prospect aside from points similar to the emotional responses. Those I maintain my cadence and plow through the challenge.

In the end, I opted not to write the MAPD.

The contact was under the impression that Medicare was paying for these procedures. 3 in total over the next year. An MAPD would have not approved this elective surgery and I didn't want a complaint to Medicare or the carrier.

How would you have handled this?

Interested in your replies.

 

[sman]

I’m posting this here because it applies to Medicare recipients of both parts A and B.

I contact a lead today whose name is not grammatically gender specific. I reach the contact and learn in the first 60 seconds that this person is transitioning. The odd part is even with my questions I couldn't figure out which way. I believe however it's female to male.

Mentioned surgeries scheduled as I'm checking Dr. and meds.

Currently has just straight A and B with a D.

Carrier covered all Dr. aside from shrink, meds (27) all covered but 1 which was easily changed to something that would accomplish the same thing...I was about to complete the enrollment when that little voice in my head said stop.

During the entire 52 min conversation, this person is having a full-on conversation with their cat. Not a hey kitty kind of conversation, this was a full blown person talking asking questions and then said person responding in a cat voice....kinda.

There were 3 emotional (raised voice and crying) outburst during the initial plan review for various questions I was asking.

I handle every call the same. My voice inflection mirrors the prospect aside from points similar to the emotional responses. Those I maintain my cadence and plow through the challenge.

In the end, I opted not to write the MAPD.

The contact was under the impression that Medicare was paying for these procedures. 3 in total over the next year. An MAPD would have not approved this elective surgery and I didn't want a complaint to Medicare or the carrier.

How would you have handled this?

Interested in your replies.

Didn't you mean will have a D? Sorry, I couldn't resist.

I knew it was only a matter of time until we started seeing cases like this. Considering the potential mental issues (based solely on the description of your conversation), I would have walked away as well.

 

[rousemark]

Didn't you mean will have a D? Sorry, I couldn't resist.

I knew it was only a matter of time until we started seeing cases like this. Considering the potential mental issues (based solely on the description of your conversation), I would have walked away as well.

Not me... I would have run... Had one psyhe case this week. one is enough! I had written the lady a FE plan.. Had problems with it from the getgo .. Thought I had everything settled. Spoke with her a couple of days ago and everything was fine.... Monday I stopped by to deliver the policy.. The front door was open with the screen door closed. I knocked and heard this voice from the yell "WHAT".. I saw he looking at me and I called her by name thinking she didn't know who I was.. She came at a dead run to the door, with fire in her eyes, screaming, " I don't have your insurance anymore. I have insurance.. Call the bank, they will tell you I have insurance."

 

[jemelton]

Run as fast as you can away. You also wasted 40 minutes of your life

 

[G.Gordon]

Nut jobs are a liability. Stay away. One fruit cake can ruin your career.

 

[somarco]

A U.S. government panel has ruled that a privately run Medicare plan must cover sex reassignment surgery for a Texas transgender woman, a decision her attorney said was the first of its kind.

UnitedHealth Medicare plan must cover U.S. sex reassignment surgery | Reuters



Currently, the local Medicare Administrative Contractors (MACs) determine coverage of gender reassignment surgery on an individual claim basis. The Centers for Medicare & Medicaid Services (CMS) proposes to continue this practice and not issue a National Coverage Determination (NCD) at this time on gender reassignment surgery for Medicare beneficiaries with gender dysphoria. Our review of the clinical evidence for gender reassignment surgery was inconclusive for the Medicare population at large. The low number of clinical studies specifically about Medicare beneficiaries’ health outcomes for gender reassignment surgery and small sample sizes inhibited our ability to create clinical appropriateness criteria for cohorts of Medicare beneficiaries.

https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=282


All this aside, I agree with the others. Run, don't walk.

 

[yogooglethis]

I’m posting this here because it applies to Medicare recipients of both parts A and B.

I contact a lead today whose name is not grammatically gender specific. I reach the contact and learn in the first 60 seconds that this person is transitioning. The odd part is even with my questions I couldn't figure out which way. I believe however it's female to male.

Mentioned surgeries scheduled as I'm checking Dr. and meds.

Currently has just straight A and B with a D.

Carrier covered all Dr. aside from shrink, meds (27) all covered but 1 which was easily changed to something that would accomplish the same thing...I was about to complete the enrollment when that little voice in my head said stop.

During the entire 52 min conversation, this person is having a full-on conversation with their cat. Not a hey kitty kind of conversation, this was a full blown person talking asking questions and then said person responding in a cat voice....kinda.

There were 3 emotional (raised voice and crying) outburst during the initial plan review for various questions I was asking.

I handle every call the same. My voice inflection mirrors the prospect aside from points similar to the emotional responses. Those I maintain my cadence and plow through the challenge.

In the end, I opted not to write the MAPD.

The contact was under the impression that Medicare was paying for these procedures. 3 in total over the next year. An MAPD would have not approved this elective surgery and I didn't want a complaint to Medicare or the carrier.

How would you have handled this?

Interested in your replies.

Was their first name Pat by any chance ?

No way I would have wrote that- double that if the enrollment was from an outbound contact!

 

[Tkruger]

A U.S. government panel has ruled that a privately run Medicare plan must cover sex reassignment surgery for a Texas transgender woman, a decision her attorney said was the first of its kind.

UnitedHealth Medicare plan must cover U.S. sex reassignment surgery | Reuters



Currently, the local Medicare Administrative Contractors (MACs) determine coverage of gender reassignment surgery on an individual claim basis. The Centers for Medicare & Medicaid Services (CMS) proposes to continue this practice and not issue a National Coverage Determination (NCD) at this time on gender reassignment surgery for Medicare beneficiaries with gender dysphoria. Our review of the clinical evidence for gender reassignment surgery was inconclusive for the Medicare population at large. The low number of clinical studies specifically about Medicare beneficiaries’ health outcomes for gender reassignment surgery and small sample sizes inhibited our ability to create clinical appropriateness criteria for cohorts of Medicare beneficiaries.

https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=282


All this aside, I agree with the others. Run, don't walk.

As always a wealth of great info! Thx somarco!!

 

[Chazm]

I'm not trying to be funny but how would you know which gender to put if you didn't know if it was a man or a woman?
Obviously you can ask but how many times do you have to ask a client which one are they? It's an odd question to ask someone.

 

[vic120]

I'm not trying to be funny but how would you know which gender to put if you didn't know if it was a man or a woman?
Obviously you can ask but how many times do you have to ask a client which one are they? It's an odd question to ask someone.

I have no knowledge of how Insurance companies would look at this so I could be wrong. However common sense tells me the birth gender should dictate cost of a supplement or only underwritten type policy as the same risk % associated with birth gender should remain the same whatever the new gender is the biology would still be the birth biology no?

If then underwritten plans would need to do it by birth gender wouldn't there be some uniformity to that

Again so much has been done in the media to make people feel right to be offended by such questions that Ins companies may not follow common sense due to political pressure