Another reason to steer clear of DSNP

[Travis Price]

I'm sure it will get worked out. Luckily she has supplies but not for more than month. I'm thinking it will be just a change of supplier. Maybe I'm being naive here too though...lmao

This is likely the solution. You have people that are trying to overcomplicate the situation.

To start, the client needs to find out who her new provider is... everything else is burrowing down a rabbit hole that doesn't make any sense.

She needs to call DHHS. They can help her. Then you can.

 

[policywunk]

She was on Original Medicare and McLaren Medicaid through state of Michigan when I met with her and enrolled her in Humana DSNP

I called Humana, got transferred around there...no one could help until I got a 4th person on the phone and even that didn't help me figure it out. ugh. This rep seemed to really want to help and certainly tried but I was still left without an answer. She spent over an hour calling around. She called the DME company where she gets her supplies. She didn't get anywhere with that...

Then the rep called Mi Medicaid and didn't get anywhere. said she has to have the enrollee call herself. Then she told me that OTC is an option that she had $69 left on there to use. That's not really going to help much but might work for a bit.

The client told me she called the DME company and they told her she doesn't have McLaren Medicaid anymore and she still doesn't know what she has. Or how to fix this...and i surely am lost now.

Are you saying Humana DSNP is responsible? And that her Mclaren Medicaid would have terminated?

Yes it would terminate.If she also has a LTC medicaid plan that would not terminate and the OTC products ( adult diapers) may also be available there.

She needs to contact Humana OTC vendor if she wants them to pay for them.

 

[AugustaMi]

This is likely the solution. You have people that are trying to overcomplicate the situation.

To start, the client needs to find out who her new provider is... everything else is burrowing down a rabbit hole that doesn't make any sense.

She needs to call DHHS. They can help her. Then you can.

Yep, overcomplicating it.

I'm just getting the client off the phone now. I did get it handled.

What I learned is that her Mclaren Medicaid was switched to Straight Medicaid (I do wonder if this was automatic after putting her into DSNP--not sure yet, need that answer if anyone knows???).

I had to call Aeroflow the company Mclaren uses (they gave me more info than anyone did and made it easy---they pulled her up and said she has straight medicaid). So then I knew J and B Medical dealt with straight medicaid, so that was a simple call, took about 10 mins to give doc and bday, medicaid #...and get her incontinence supplies ready to roll.

Where I screwed up is calling Humana and letting that rep help...lol. The whole Friday thing was a waste of time. That confused me and left things more undone than to begin with.

So I did have the client call Mclaren--they get a recording...and it's convoluted still bc the recording tells her shes active when she's showing up straight medicaid now a two places. So the client couldn't figure this out. I've seen this before with Meridian with a fam member and just kind of have to go with the flow and hope for the best. So her calling was no use too.

I can't leave stuff undone...so now what about if this were to happen with someone with feeding tubes/formula/supplies. super flimsy imo. This is just incontinence supplies but...you know.

 

[AugustaMi]

Yes it would terminate.If she also has a LTC medicaid plan that would not terminate and the OTC products ( adult diapers) may also be available there.

She needs to contact Humana OTC vendor if she wants them to pay for them.

Ok this would make sense.


Thank you, So they all go on straight medicaid when enrolled into a DSNP, UNLESS they have LTC-or like- medicaid-- LOL UGH. First time Ive heard this but looks like what happened. If this is all it is, then that makes things easier to comprehend. BC her Mclaren supposedly dropped in Jan when her DSNP became active. It's just now getting caught.

The part about Humana OTC doesn't make sense though bc J and B medical here will pick up her supplies with straight medicaid.

I promise I'll stop beating this horse now. UGH. Take it easy on me, I'm just learning this and every single day it's something new. I always appreciate the help.

 

[Travis Price]

Solution?

Don't eff with DSNP

Gus' face tells you how I feel about it.

 

[policywunk]

Ok this would make sense.


Thank you, So they all go on straight medicaid when enrolled into a DSNP, UNLESS they have LTC-or like- medicaid-- LOL UGH. First time Ive heard this but looks like what happened. If this is all it is, then that makes things easier to comprehend. BC her Mclaren supposedly dropped in Jan when her DSNP became active. It's just now getting caught.

The part about Humana OTC doesn't make sense though bc J and B medical here will pick up her supplies with straight medicaid.

I promise I'll stop beating this horse now. UGH. Take it easy on me, I'm just learning this and every single day it's something new. I always appreciate the help.

JM Medical may accept medicaid and medicare but what matters here is if they are an approved vendor for the OTC benefits since these supplies are not covered my medicare.Before you switched her you you should have verified this if she wanted to stay with same supplier and also make sure her OTC benefits amount on the MA plan was as as much as her medicaid plan was.- which usually it is.Main thing to avoid complaints is to not do a client dirty.The SNP plans can be complicated to sell correctly but for me it has been worth it.

 

[AugustaMi]

Tha

JM Medical may accept medicaid and medicare but what matters here is if they are an approved vendor for the OTC benefits since these supplies are not covered my medicare.Before you switched her you you should have verified this if she wanted to stay with same supplier and also make sure her OTC benefits amount on the MA plan was as as much as her medicaid plan was.- which usually it is.Main thing to avoid complaints is to not do a client dirty.The SNP plans can be complicated to sell correctly but for me it has been worth it.

Thanks PW. This was the missing link I needed.

Got it, going forward, keep it real and get the DME info/verify vendor/OTC benefits. Not one person mentions this in any of the videos/training/ etc. Another "learned it here first" moment.

Don't want to build Rome on these, but it sure is a nice supplement when it's done right with rapport and support, a little extra due effort. Doesn't have to be as hard as I made it. Glad it didn't get too sticky with the client although she was a snapper at me, but not complaint ready.

 

[Jeffrey_G]

I already steer clear of this demographic as it is... the chances of writing ancillary products of any real merit is much lower. LTC... forget it. Annuities... forget it? Pretty much everything else... forget it.

 

[AugustaMi]

Solution?

Don't eff with DSNP

Gus' face tells you how I feel about it.View attachment 7880

Right, .thats how I feel too, my day job really doesn't allow time to hand hold. what PW said is correct, but you know what? Even today different answer was given. Today new supplier said Humana is picking it up --wouldn't say how much or anything-no mention of OTC-yep different answer today bc yesterday it was straight medicaid.

Next they'll probably call and say nevermind it's OTC. Happened to talk to my Humana main rep today, he said same thing policywunk said . He's like oh yah, most DSNP plans give enough OTC to cover these items. "Most" being the key word. In her case it won't be enough. The fatter benny DSNPS are not in her area, although would do the trick. So I probably messed this one up if her Medicaid in fact was covering all the cost b4 I put her on DSNP. I'm aware of the probable mistake and own it. Live and learn. I do know regular MAPD it would be OTC, but.... here's what,

FMO and my upline to all newer agents: "DSNP is great. Never a hassle bc everything and more is covered." Me this week: Ok, here's DSNP appt you can have. Upline: "No can't today, I don't have time." hahaha. In my head: yep, ciao!, there's a reason for being too busy, and I know what it is...1. you can't cross-sell. 2. headaches

Back to the T65 locator tomr. DSNP shelved, rant done. I'll hear from her again, I'm sure. She is half mile from my office. She will probably come in eventually ready to claw my eyes out bc she has to pay $150 OOP for some briefs bc the $150 her Humana gives only covers a month and a halfs worth.