Help! Sep problem

[insurance0707]

What is wrong with these insurance companies! I'm tired of having to educate these people over the phone....here's my problem

I wrote a client an MAPD plan when she turned 65 in Nov. 2007. I told her, as I tell all of my clients, if for any reason you're not happy with it you have a 12 month trial period where you can go back to Medicare, a Medicare supplement and a PDP plan. 8 months later she decides she'd like to change and go with a Med sup and PDP plan. So I switch her over to a med sup and PDP plan. The PDP plan is with Humana. I called Humana before submitting the app. I asked them before I submitted the app what the SEP code would be because I needed to enter it onto the app. At first they said, no you can't do it. I then explained the SEP and yes she could. After researching and being put on hold for forever they finally said yes you're right you can. Got the correct code SEP 65, sent in the app, got rejected. There reason she didn't have an SEP. I called and explained again and they said yes you're right there is an sep. Still no approval after 2 weeks. Called again, had to reeducate the person I spoke with, had to fax in the supporting evidence which i did and was assured it would be issued. Called again, still not being issued. I have to explain each time that there is an SEP and after they keep me on hold for eternity they agree there s an SEP and they'll send it down to the enrollment deparment where it's continuously rejected by the enrolment department saying she doesn't have an SEP.

Should I just skip the insurance company and have the client call CMS and explain what the insurance company is doing.

Humana is great if you just have an ordinary case but if you submit an app with an out of the ordinary SEP they're awful. I've been hung up on twice while trying to get the situation fixed. It's like it's just too much of a bother for them. After explaining the situation politely, they say, can I put you on hold for a moment and then the next thing I know i get the busy signal, they've disconnected me.

Anyone experiencing this?????

Any recomendations on how to get his taken care of quickly.

Sorry this is so long, please insurance-forums.net please don't disconnect me too! lol I'm just extremly frusterated. This was a 7-1-08 issue date and it's still not resolved.

 

[insurance0707]

I guess my other option would be to fly down to Kentucky, meet the enrollment department and give them all a 2 page list of the SEP's that are available. When I call Humana, I tell them it's # 31 on the SEP chart. They tell me they don't have this chart. I also tell them (thanks to the info I got on this board) that's it's listed on page 19 of your Guide to Medicare, which they don't seem to have either.

 

[AgentOrange]

I dont think she can do what youre telling her ... she has iep 3 months before and after her birthday but if she enrolls she should be locked in until aep. Is she eligible for a state prescription assistance program ? what state are you in ? Just out of curiosity why did you opt not to sell her a supp and a pdp ?

 

[insurance0707]

Agent Orange, everyone has a 12 month trial period if it's there first time going on an MA plan or an MAPD plan. If you're just turning 65 and go on an MAPD plan you have a 12 month trial period, if you elect to use the trial period to disenroll you list a code of SEP-65

If you're not 65 and already on a Med supp and decide you want to try out an MAPD plan, you also have a 12 month trial period. If you decide you want to go back to your old med supp you would use the SEP code of SEP-Trial

There are over 60 SEP's for a person to get out of an MAPD or MA plan.

 

[insurance0707]

I dont think she can do what youre telling her ... she has iep 3 months before and after her birthday but if she enrolls she should be locked in until aep. Is she eligible for a state prescription assistance program ? what state are you in ? Just out of curiosity why did you opt not to sell her a supp and a pdp ?

I opted not to sell her a Med supp and pdp at the time because the area that she lives in the med supp premiums were very high. She lives in the Detroit area and Detroit always has higher insurance premiums whether it's car insurance, heatlh insurance, etc. AARP came into our state 2 months ago and allowed agents to write their product. AARP charges everyone the same premiums in Michigan regardless of where you live. The client called me and told me her husband was turning 65 so I brought up AARP. She wanted to go with it also. That's why I switched her.

 

[insurance0707]

AARP has always been in our state, they just started letting agents write their plans a couple of months ago

 

[midwestbroker]

Humana has always had problems with unique situations. They are like a mini government...takes 40 people to do one thing after they have about 6 meetings on it.

If you know you are in the right, tell the client to call Humana and inform them that they will be getting the DOI involved. You will be surprised how fast things get done after that...

 

[cadylou]

The 12 month trial period (guaranteed issue right) where someone tries an advantage plan & wants to go back to Medicare refers to your right to have the med supp company issue you a policy with no medical underwriting within that 12 months. It makes no reference to the drug plan (PDP) - if the person jumps back to medicare in the summer, they'd have to wait for AEP to pick up a PDP again. As far as "getting out of a med supp" - you can discontinue a supplement any time you want - but you can only initially sign up for Medicare Advantage during the AEP and the OEP each year.

 

[Kimber]

Actually, there's a catch. If you look in the Federal PFFS Guide, it says that you have a 12 month trial in which you can return to your original Med Supp, however, if you didn't have a Med Supp to begin with you are stuck. Can't move until Open Enrollment (sorry for the bad news, but I learned this the hard way.) I have a copy of the guide that I will share if anyone wants it.

 

[retread]

Actually, there should be no problem with this scenario. She had taken a MAPD when turning 65. The rules are very straight forward about this. She has a 12 month trial period in which she has the right to opt out of the MAPD and can get a Med Sup AND a PDP (in this case she had a MA-PD, so she has the right to pick up a stand-alone PDP). Furthermore, she has the right to ANY MedSup sold in her state. (Not so with those that had former MedSups they left in favor of a MA plan.) This lady is fully protected.

Read page 19 of the "2008 Choosing a Medigap Policy", trial right #4. She has a time constraint of applying for a MedSup of 60 days before and 63 days after her MAPD coverage ends. I would suggest that she be encouraged to keep copies of all correspondence of this screw-up. This is nothing more than a hassle, and she is holding the trump cards under the circumstances. Humana will be strung out to dry on this one.