Wrong Info Coming Out Of 1-800-MEDICARE

Joe Moore · 01-01-2009, 07:41 AM

Who else has had similar problems with wrong info coming out of 1-800-MEDICARE?

We had a interesting situation in our office yesterday afternoon. One of my sons had placed a Full Dual Eligible (Medicare and Medicaid) client in a MAPD PFFS -0- premium plan about 10 days ago.

In Tennessee, Medicaid (TennCare) pays Full Duals copays left by the plan. So it can be a better deal for the client with limited Hearing, Dental and Vision Benefits and some more minor bells and whistles from the plan. The client would of course still pay the lowered drug copays, as with any Part-D plan. There have not been any provider issues with this plan in our area.

This client had called Medicare and was told by some Medicare genius that she had been "taken out of Medicare" and did not at all need to be in this plan. So, this genius "fixed it". He took her out of the plan my son had placed her in, and moved her to another company (I guess the company of his choice). He also sent word by the client to my son that we did not need to do anything, because he had "fixed the problem".

Although we hear this phrase often coming out of doctor's offices, this is the first time I have heard the "taken out of Medicare" statement actually coming out of Medicare. If an agent had made this wrong statement, he/she would probably bring the wrath of CMS on them.

Of course this "expert" on the other end of the phone was right, and my son was the villain--just another dumb greedy insurance agent in the client's view.

Does anyone have a clue what type of training the 1-800-MEDICARE phone folks have to go through? Seems with some of them, the training and knowledge is very lacking. Any similar stories out there?

*midwestbroker* · 01-01-2009, 08:19 AM

Medicare Help Line Falls Short, GAO Finds

Basically states that if you call 1-800 Medicare, you have a 29% chance of getting the wrong answer and another 10% of getting no answer at all.

There have been newer reports saying that it has improved...BUT...

I called 1-800Medicare a few months ago saying that my father is aging into Medicare and I was researching Part D plans. Got the wrong info over the phone. They said the gap was different for each plan.

Most people I talk to who have called Medicare were not pleased.

retread · 01-01-2009, 09:23 AM

Originally Posted by Joe Moore

Who else has had similar problems with wrong info coming out of 1-800-MEDICARE?

We had a interesting situation in our office yesterday afternoon. One of my sons had placed a Full Dual Eligible (Medicare and Medicaid) client in a MAPD PFFS -0- premium plan about 10 days ago.

In Tennessee, Medicaid (TennCare) pays Full Duals copays left by the plan. So it can be a better deal for the client with limited Hearing, Dental and Vision Benefits and some more minor bells and whistles from the plan. The client would of course still pay the lowered drug copays, as with any Part-D plan. There have not been any provider issues with this plan in our area.

This client had called Medicare and was told by some Medicare genius that she had been "taken out of Medicare" and did not at all need to be in this plan. So, this genius "fixed it". He took her out of the plan my son had placed her in, and moved her to another company (I guess the company of his choice). He also sent word by the client to my son that we did not need to do anything, because he had "fixed the problem".

Although we hear this phrase often coming out of doctor's offices, this is the first time I have heard the "taken out of Medicare" statement actually coming out of Medicare. If an agent had made this wrong statement, he/she would probably bring the wrath of CMS on them.

Of course this "expert" on the other end of the phone was right, and my son was the villain--just another dumb greedy insurance agent in the client's view.

Does anyone have a clue what type of training the 1-800-MEDICARE phone folks have to go through? Seems with some of them, the training and knowledge is very lacking. Any similar stories out there?

Joe... it is time we start holding Medicare accountable for their unethical behavior. Please call your congressman and complain about this. You have a classic case of "churning" on the part of Medicare!

jdeasy · 01-01-2009, 11:19 AM

Happens all the time, Joe. I've had a Medicare rep tell a person the very same thing. The problem for the agent is that, once Medicare has planted that seed, it's almost impossible for you keep the fruit from growing.

G.Gordon · 01-01-2009, 03:03 PM

Yep... there are a bunch of $6/hour morons that make our lives hell on the other end of that number. I can't tell you how many times I've had to "teach" the "benefits specialist" about beneficiary Rights and Protections concerning a SEP for exiting MA plans within the first 12 months.

I've actually had to have them READ the rights and protections one by one until they got to the applicable one and then say... "That's it!!!" "That's the one I'm talking about." One actually still wanted to argue with me... I hung up, called back, and started over and got what I wanted.

MedicarePlanSolutions · 01-01-2009, 03:44 PM

Usually the only thing I'll use Medicare for is to verify eligibility and effective dates. I don't know what they make, but my biggest challenge with them is they don't seem to care about the agent or the member.

MedSuppPro · 01-01-2009, 05:37 PM

[quote=MedicarePlanSolutions;124134I don't know what they make, but my biggest challenge with them is they don't seem to care about the agent or the member.[/QUOTE]

1-800Medicare is a 3rd party contracted entity just like agents are 3rd party contracted entities.

The only difference is the 1-800Medicare people didn't wake-up on the 24th of December to find out their contract had been retroactively re-revised downward for the third time in as many months.

Nobody in any of the Federal CMS government offices has received a retroactive pay decrease.

What a joke!

Newby · 01-01-2009, 07:51 PM

This happened to me yesterday!

I had a lady who had her letter that she was approved for Medicare A & B. The letter had her effective date (she's under 65 on disability) and the claim number was her SS# with HA at the end of it. I'd never seen an HA and since it was December 31st I wanted to call and verify.

Luckily I had her on speaker phone so the client could witness how lame the Medicare employee was. I asked if her Medicare number really ends in HA or if it is just A and the genious told me "it's just A. They all are the SS# with an "A" at the end.

I actually had to insist that she look this one up in the system to verify. It was news to her that some people have other letters besides "A" and some even have a spouse's SS#

stormtracker · 01-01-2009, 08:24 PM

It's not only Medicare that is giving out ridiculious information. I've had home health providers, pharmacists, etc..., tell my customers that they either didn't need, or shouldn't have changed to, a plan that I wrote for them. To my knowledge, none of these trusted professionals were LICENSED to render such an opinion. It amazes me that CMS chases licensed agents to no ends, but ignores laymen who are out there advising seniors in insurance matters. How is it acceptable, or even legal, for a pharmacist to advise seniors on part D options??? God help me for the wrath I'd receive if I advised a senior on prescription drug choices...

jdeasy · 01-01-2009, 08:30 PM

Originally Posted by Newby

This happened to me yesterday!

I had a lady who had her letter that she was approved for Medicare A & B. The letter had her effective date (she's under 65 on disability) and the claim number was her SS# with HA at the end of it. I'd never seen an HA and since it was December 31st I wanted to call and verify.

Luckily I had her on speaker phone so the client could witness how lame the Medicare employee was. I asked if her Medicare number really ends in HA or if it is just A and the genious told me "it's just A. They all are the SS# with an "A" at the end.

I actually had to insist that she look this one up in the system to verify. It was news to her that some people have other letters besides "A" and some even have a spouse's SS#

There is an HA desgnation. I ran into another one I had never seen before recently. I can't remember what it was, but, it was two letters at the end on the card.

*midwestbroker* · 01-01-2009, 08:50 PM

Here are the Medicare suffixes and what they mean

Answer

Joe Moore · 01-01-2009, 08:53 PM

Originally Posted by Newby

This happened to me yesterday!

I had a lady who had her letter that she was approved for Medicare A & B. The letter had her effective date (she's under 65 on disability) and the claim number was her SS# with HA at the end of it. I'd never seen an HA and since it was December 31st I wanted to call and verify.

Luckily I had her on speaker phone so the client could witness how lame the Medicare employee was. I asked if her Medicare number really ends in HA or if it is just A and the genious told me "it's just A. They all are the SS# with an "A" at the end.

I actually had to insist that she look this one up in the system to verify. It was news to her that some people have other letters besides "A" and some even have a spouse's SS#

Here is some helpful information. We keep this in our office and supply it to our in-house agents, as Medicare should.

Answer

You may want to print this off. It can save time and avoid wrong answers.
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Originally Posted by retread

Joe... it is time we start holding Medicare accountable for their unethical behavior. Please call your congressman and complain about this. You have a classic case of "churning" on the part of Medicare!

This will be done tomorrow. I was planning on doing it, but you inspired me to make it sooner, better than later. Thanks retread.
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Originally Posted by stormtracker

It's not only Medicare that is giving out ridiculious information. I've had home health providers, pharmacists, etc..., tell my customers that they either didn't need, or shouldn't have changed to, a plan that I wrote for them. To my knowledge, none of these trusted professionals were LICENSED to render such an opinion. It amazes me that CMS chases licensed agents to no ends, but ignores laymen who are out there advising seniors in insurance matters. How is it acceptable, or even legal, for a pharmacist to advise seniors on part D options??? God help me for the wrath I'd receive if I advised a senior on prescription drug choices...

Agents are "soft targets". No organizations, no attorneys, no money and no lobbying groups.
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Originally Posted by midwestbroker

Here are the Medicare suffixes and what they mean

Answer

Well at least we both went looking.
And we found the same reference.
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Originally Posted by stormtracker

It's not only Medicare that is giving out ridiculious information. I've had home health providers, pharmacists, etc..., tell my customers that they either didn't need, or shouldn't have changed to, a plan that I wrote for them. To my knowledge, none of these trusted professionals were LICENSED to render such an opinion. It amazes me that CMS chases licensed agents to no ends, but ignores laymen who are out there advising seniors in insurance matters. How is it acceptable, or even legal, for a pharmacist to advise seniors on part D options??? God help me for the wrath I'd receive if I advised a senior on prescription drug choices...

You can add to that list relatives, neighbors, friends, pastors, and anyone else that has ever heard of a Part-D.

We had a director of a senior citizen center send a member to Walgreens, so they could determine the best plan for her. Walgreens has a print-out they supply of the best plans considering the drugs used. This was an underage disabled person and when she asked about better health coverage than Original Medicare, the Walgreen's lady had no answer.

The client finally found us when her brother-in-law told her he had coverage with us.

Also, some Mom and Pop drug stores are recommending a certain plan that has no mail-order (don't tempt the client). It usually has much higher premiums to the client, but a higher reimbursement to the drug store.

MedSuppPro · 01-02-2009, 08:13 AM

Originally Posted by Joe Moore

- - - - - - - - - - - - - - - - - -
Quote: Originally Posted by retread
Joe... it is time we start holding Medicare accountable for their unethical behavior. Please call your congressman and complain about this. You have a classic case of "churning" on the part of Medicare!

This will be done tomorrow. I was planning on doing it, but you inspired me to make it sooner, better than later. Thanks retread.
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I would hold your powder... Acting CMS Administrator Kerry Weems is currently cleaning out his desk. Kerry Weems will be rewarded for his 3rd commission revision and his 5 year Agent-Client Term-Limit. He will ride off into the $unset of humana life. Mark my words -- this guy will be rewarded for his efforts to thwart the replacement of bad plans.

Indy agents are agents of change. They shut us down because of our ability to help our clients.

I will start 2009 with a letter to Tom Daschle, the new director of CMS, and will send copies to my US Senators and Representative:

1.) I will request sanity replace the divider's CMS Katrina mentality. We need to be partners with CMS. We are certified and contracted third parties and we should be treated the same as their other third party contracted parties (i.e. Call Centers).

2.) I will request the removal of the non-consumer friendly 5 year Rent-A-Agent Term-Limit. My clients don't deserve to be left out in the cold so that carriers can profit. Our Clients need our continued advice and counsel.

3.) I will request the removal of the "Cherry Picking" FIRST year commission rule. My turning 65's are being hammered by MA offers. First year should be the same regardless of prior coverage history. We spend that same amount of time regardless of prior plan history.

My letter will not be about me. I will not complain about my retroactive commission cuts. My letter will give real life stories of Medicare eligible’s who have been directly impacted by the current CMS mismanagement. I know there are other issues. I will keep it simple and stick with the 3 above.

*midwestbroker* · 01-02-2009, 08:30 AM

Excellent post Medsupp.

stormtracker · 01-02-2009, 09:26 AM

The only thing anyone associated with CMS is concerned about it keeping the train on the tracks. Doesn't matter where in the hell it goes-- just that it is on the tracks...

Joe H · 01-06-2009, 08:22 PM

"We had a director of a senior citizen center send a member to Walgreens, so they could determine the best plan for her. Walgreens has a print-out they supply of the best plans considering the drugs used. This was an underage disabled person and when she asked about better health coverage than Original Medicare, the Walgreen's lady had no answer."

The information the so-called Professionals are giving to the seniors is horrible. Senior citizen volunteers at the local elder centers are mis informed, over step their boundaries and trash our reputations.

They have ZERO training, ZERO oversight, and think they know all about this stuff...I've seen ,and heard dozens of times these people giving seniors wrong advise and telling them to stay clear of the insurance guys.

How can they get away with this untrained misinformation and if we sneeze with out three signed forms two weeks in advance we get creamed....

The sad part is the senior gets hurt.....Next time some billing clerk/nurse/ pharmacist/ senior advocate comes near me or one of my clients I'm going at them with "are you CMS certified in these products"......"than the information you have given out could put you in a financial lawsuit with the seniors you advise, be careful very careful"........actually they probably could be sued if their not certified. Where's a lawyer when you need them..

*midwestbroker* · 01-06-2009, 08:49 PM

One way to combat this is to carry a Medicare and You book. I have mine all marked up and highlighted.

So, when a client tells me that they do not have the same rights under a MA plan as they do with Medicare, I can show them page 52.

If they say they lost their Medicare coverage I turn to page 50 and show them these plans are part of Medicare.

If they have Medicaid I show them page 82

New to Medicare...page 43 for the chart of their options

Have a supp and worried about changing to a MA...page 76 shows them they have a 12 month window (if they go back they will pay the current premium rate)

Got group insurance and looking at MA plans...page 57

Etc...etc...

Show them it in writing in Medicare's book. If they do not believe you, then do you really want them as a client?

retread · 01-06-2009, 10:09 PM

Originally Posted by midwestbroker

One way to combat this is to carry a Medicare and You book. I have mine all marked up and highlighted.

So, when a client tells me that they do not have the same rights under a MA plan as they do with Medicare, I can show them page 52.

If they say they lost their Medicare coverage I turn to page 50 and show them these plans are part of Medicare.

If they have Medicaid I show them page 82

New to Medicare...page 43 for the chart of their options

Have a supp and worried about changing to a MA...page 76 shows them they have a 12 month window (if they go back they will pay the current premium rate)

Got group insurance and looking at MA plans...page 57

Etc...etc...

Show them it in writing in Medicare's book. If they do not believe you, then do you really want them as a client?

I think we are two guys running in the same ditch.... I use the Medicare & You book in every presentation. As a matter of fact, I have them fetch THEIR copy, have them dog-ear page 50, show them the back cover with the SHIP info, and when I come to the required reading paragraph on the app where it talks about "Counseling services may be available in my state...", I say "remember that info on the back of your Medicare & You book?"... all this goes a long way to reassuring them the plan is integrated with Medicare.

jdeasy · 01-06-2009, 10:25 PM

Originally Posted by retread

I think we are two guys running in the same ditch.... I use the Medicare & You book in every presentation. As a matter of fact, I have them fetch THEIR copy, have them dog-ear page 50, show them the back cover with the SHIP info, and when I come to the required reading paragraph on the app where it talks about "Counseling services may be available in my state...", I say "remember that info on the back of your Medicare & You book?"... all this goes a long way to reassuring them the plan is integrated with Medicare.

There's 3 of us then. I never make a presentation, even on a replacement, without using the Medicare and You booklet.

It's amazing to me still the people that are on MA plans and have never had it explained to them. I met with a couple this morning that had been on Coventry's Advantra Freedom for 2 years and looked at me with wide eyed wonder when I went over page 50. I asked them how they got on the plan and they said "some guy did it over the phone".

theinuranceguy · 01-07-2009, 01:06 AM

I aslo use the Medicare & You Handbook, however, are we allowed to use that?

I always show my clients the plan I recommend to them in the back of the book, the back of the book also has every other plan in the county.

Does anyone know for a fact that we are even allowed to use the Handbook?