Need Advice on Issue with Humana PDP

russelltw

Guru
1000 Post Club
1,257
Board,
I am at my wits end with Medicare and Humana (PDP). I have a client who I helped enroll into a Humana PDP on 12/29/12 (enrolled and received confirmation from Medicare.gov). They had an SEP (losing group coverage) and were initially enrolled with Humana. Humana then disenrolled them the same day saying they did not qualify. Both the client and I have called Medicare and they say it's Humana's problem. Humana says that the client did everything right, but since Humana received the application from Medicare on 1/2/13 they could not enroll them and the earliest effective date is 2/1/13 now. Medicare says Humana can backdate the PDP for 1/1/13 and Humana says it can be done, but no one at Humana seems to have the authority to backdate the coverage.

Client spent 2 hours on the phone with the billing and enrollment department and had no luck. I am not licensed with Humana, so I cannot make much headway with them. Do anyone here know of someone at Humana that could make this happen?
R
 
I think it will be hard for you to be of much help if you aren't licensed with Humana. When I have issues my marketing rep at the FMO has inside connections and takes care of it for me. Sometimes if you keep calling Medicare until you get someone that's competent that helps. I can tell the first 10 seconds if they are going to be of any help and if not I hang up and hit redial. Some of them are really good and will go over and beyond to try and help you and your client.
 
What date did their employer coverage end? They have 63 days from the day their plan terminates. The SEP election period code needs to be LEC for this to work. They can simply renroll using this code if they are still within that timeframe, otherwise they will have to file a complaint at 1800medicare and force a new SEP.
 
Their group coverage ended on 12/31/12. Jacob, are you saying they can backdate the coverage when they enroll even though it has passed (1/1/13 is what they want and should have). They could apply today via medicare.gov and backdate it to 1/1/13?

UPDATE: just spoke with medicare and they said it can not be backdated. Client wants to have a 1/1/13 effective date and Humana agrees that should be the case, but no one there wants to fix the problem other than write a 2/1 effective date. Client is the "fighting" type and likes challenges, so the 2/1 effective date is not an option because he applied before he lost coverage for a 1/1/13 effective date. Humana says since they received the application on 1/2/13, the computer system disenrolled them.
 
Last edited:
Good luck. I had a similar problem with them in Nov with an IEP enrollment where I was AOR. They rcvd app in mid Nov for Dec effective date. They never issued policy and when we found problem in Dec, they said they could not fix it for 12/1, even though in was their error. Customer filed complaint with Medicare which seems to have had no affect.
 
Their group coverage ended on 12/31/12. Jacob, are you saying they can backdate the coverage when they enroll even though it has passed (1/1/13 is what they want and should have). They could apply today via medicare.gov and backdate it to 1/1/13?

UPDATE: just spoke with medicare and they said it can not be backdated. Client wants to have a 1/1/13 effective date and Humana agrees that should be the case, but no one there wants to fix the problem other than write a 2/1 effective date. Client is the "fighting" type and likes challenges, so the 2/1 effective date is not an option because he applied before he lost coverage for a 1/1/13 effective date. Humana says since they received the application on 1/2/13, the computer system disenrolled them.

Let him "fight" all day and night if he wants to. In the mean time, tell him to enroll now for a 2/1/13 effective date. Waiting until the last min never helps.

I was never into "helping clients enroll" in PDP's via medicare.gov. The best way to help your client is to print out the plan finder results and mail it to them, and highlight the enrollment phone number. This way you can still be helpful but at the same time, not involved and not responsible for the many PDP headaches sure to come...
 
Focus LTC,
I used to do that until Humana stole one of my clients and convinced her to get a MA plan as opposed to a med supp and a humana PDP. She told me they sent her to the sales department and told her how much better a MA plan would be instead of a simple PDP. She calls me later to thank me and tell me how much money she is saving. Six months later, the phone call is a bit different. Should have been on the med supp...
That is why I am doing this now. Did not want to make a habit of feeding Humana my med supp clients. I guess the obvious answer is to not recommend Humana...
 
Focus LTC,
I used to do that until Humana stole one of my clients and convinced her to get a MA plan as opposed to a med supp and a humana PDP. She told me they sent her to the sales department and told her how much better a MA plan would be instead of a simple PDP. She calls me later to thank me and tell me how much money she is saving. Six months later, the phone call is a bit different. Should have been on the med supp...
That is why I am doing this now. Did not want to make a habit of feeding Humana my med supp clients. I guess the obvious answer is to not recommend Humana...

I overlooked that possibility because Humana does not have an MA in my state and therefore does not try to pick off my clients. That is dirty business.

Maybe 1800MEDICARE? I remember Stastny use to send his clients to their pharmacy during Open enrollment. That won't always get them the best plan and now with agents hiding out in pharmacies during OE opens you up to competition.

Being involved and powerless is not a combination I enjoy and by the looks of it, you hate being in that situation too. If I'm somehow involved I want to have a say or I don't want to be involved at all.

What to do, what to do..... This part of the job sucks. How bad is it if he goes 1 month without coverage?
 
Back
Top