Cryptic Message from Cigna-HealthSpring

[Ronnie Carter]

Guys, I got this email message today:

Dear Valued Agent/Agency,
We mistakenly charged back December 1 termination dates, which are completely exempt from chargebacks if:

1. The beneficiary enrolled for effective dates October 1, November 1, or December 1
2. The beneficiary is new to Medicare and enrolled in calendar year 2014.

We discovered this error and have since corrected it. This may have resulted in underpayments for any enrollments you submitted for this time period. We are reversing the chargebacks in the April 17, 2015 payment.

We apologize for this error ....

Do any of you C-HS agents out there know what the #&$% they're talking about? How could you terminate a plan on the first day of the month, rather than the last day? The way I read this, if I enrolled a new Medicare beneficiary last year with an effective date of 12/1/14 and they terminated the same day, I should NOT be charged back, which makes no sense.

What the heck?

Normally I think I understand plain English pretty well but this one has my mind boggled. If anyone can translate, it'll be appreciated.

 

[WCMason]

They are referring to rapid disenrollments which are normally charged back 100% even if the member is in the plan for three months. An exception to that is an Oct-Dec enrollment that terms 12/31 because the member completed the plan year. For those the agent is to be paid for the number of months enrolled. It sounds like they charged back all three months when some should have only been charged back for one or two.

I am formerly contracted with them for MA/PDP; did not recert this year due to their quotas on MA plans and non-comp on PDP plans. I'll consider selling their med sups again--still contracted there--if they start treating agents better.

 

[Ronnie Carter]

They are referring to rapid disenrollments which are normally charged back 100% even if the member is in the plan for three months. An exception to that is an Oct-Dec enrollment that terms 12/31 because the member completed the plan year. For those the agent is to be paid for the number of months enrolled. It sounds like they charged back all three months when some should have only been charged back for one or two.

I am formerly contracted with them for MA/PDP; did not recert this year due to their quotas on MA plans and non-comp on PDP plans. I'll consider selling their med sups again--still contracted there--if they start treating agents better.

Thanks very much, I should have deduced all that from their message!

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