Appealing Part D late charge

[yorkriver1]

Any experience with long term prior creditable coverage proof?
The client has retired into their 70's. the span of time for creditable coverage will include the first 4 of 12 years ago, when the first employer went out of business. The client doesn't have a record of the insurer. They have a letter from the PDP carrier with the appeal application attached.

 

[TwoCents]

Need to clarify some things. Is it the client's first Part D enrollment and they just didn't turn in the attestation form on time or answered it incorrectly?

If it's not the client's first Part D plan and the LEP was assessed by a prior carrier, I would say it's less likely that they'd win an appeal. All you can do is have them submit it to the CMS contractor and go from there.

 

[LostDollar]

Any experience with long term prior creditable coverage proof?
The client has retired into their 70's. the span of time for creditable coverage will include the first 4 of 12 years ago, when the first employer went out of business. The client doesn't have a record of the insurer. They have a letter from the PDP carrier with the appeal application attached.

how did they prove health ins coverage for the L564 for their part B application?

 

[yorkriver1]

how did they prove health ins coverage for the L564 for their part B application?

If I recall, they spoke to a local Social Security rep to complete the process for Part B. Will bring that up, if needed.

 

[yorkriver1]

Need to clarify some things. Is it the client's first Part D enrollment and they just didn't turn in the attestation form on time or answered it incorrectly?

If it's not the client's first Part D plan and the LEP was assessed by a prior carrier, I would say it's less likely that they'd win an appeal. All you can do is have them submit it to the CMS contractor and go from there.

It is the first time, and they just forgot that I told them several times they would wind up needing to track back to earlier insurance once the Part D plan issued their policies.

 

[TwoCents]

It is the first time, and they just forgot that I told them several times they would wind up needing to track back to earlier insurance once the Part D plan issued their policies.

He doesn't need to submit proof. Let's say client turned 65 on 1/1/23 and kept working and didn't need to pick up Part D. Then he retires and joins Part D 1/1/24. CMS and the plan would see that as a 12-month gap that needs to be accounted for. The plan sends a letter "hey did you have creditable coverage during these 12 months? If yes, pick the source from this form and fill in the dates." The form can be returned or the info can even be given over the phone.

You're missing a piece of the puzzle here.

 

[yorkriver1]

What am I missing--besides perhaps not being perfectly clear. If the person is 77 and just retired, dropped employer coverage upon enrollment in Part B, and has to attest they had creditable drug coverage from the group plan(s) since age 65 and can't locate the info for the 1st 4 years after T65 because that employer went out of business, no record of the plan information, and then ignored the request from the PDP plan for creditable Rx coverage past the 60 days, they now have a letter which includes the appeal form and a notice that the penalty is $26/month if they can't prove creditable coverage. On what basis are you saying there is no proof needed? Not being argumentative, I may not have been clear enough on here.

 

[Chazm]

What am I missing--besides perhaps not being perfectly clear. If the person is 77 and just retired, dropped employer coverage upon enrollment in Part B, and has to attest they had creditable drug coverage from the group plan(s) since age 65 and can't locate the info for the 1st 4 years after T65 because that employer went out of business, no record of the plan information, and then ignored the request from the PDP plan for creditable Rx coverage past the 60 days, they now have a letter which includes the appeal form and a notice that the penalty is $26/month if they can't prove creditable coverage. On what basis are you saying there is no proof needed? Not being argumentative, I may not have been clear enough on here.

Learned this recently, but all they have to do is say, yes I’ve had coverage. You don’t have to prove it. I always thought you had to show proof.

 

[yorkriver1]

Learned this recently, but all they have to do is say, yes I’ve had coverage. You don’t have to prove it. I always thought you had to show proof.

But does that apply, now that they have received an appeal form?

 

[LostDollar]

Learned this recently, but all they have to do is say, yes I’ve had coverage. You don’t have to prove it. I always thought you had to show proof.

When I did it, I did not have to "provide proof", but I did have to state, over the phone, either carriers or employers, I don't remember which.

The oral information I provided had to be more descriptively detailed than a statement like "I had creditable coverage".