Client Moved Out of MA HMO Service Area

[bill3173]

Med Supp Client moved from NY recently, and when I first met with her, I told her that she would have to notify the carrier of her address change and they would issue an involuntary DE letter because she moved out of the service area. I stressed that in NC this letter is required for her to be GI. She sent me a generic DE letter from the carrier yesterday, incicating voluntary de and no change of service area.

Any of you replacement pros run into this, and how'd you handle it. Just checking to see if anyone knew any cute tricks, this lady has a lot of trouble understanding what is required.

 

[Bill_Kiray]

Med Supp Client moved from NY recently, and when I first met with her, I told her that she would have to notify the carrier of her address change and they would issue an involuntary DE letter because she moved out of the service area. I stressed that in NC this letter is required for her to be GI. She sent me a generic DE letter from the carrier yesterday, incicating voluntary de and no change of service area.

Any of you replacement pros run into this, and how'd you handle it. Just checking to see if anyone knew any cute tricks, this lady has a lot of trouble understanding what is required.

Was this client's coverage in NY a Medicare Advantage plan (as in your thread title), or was it Medicare Supplement (as in the text of your post)? Please let me know, and I'll reply back with some potential guidance.

 

[jdeasy]

Was this client's coverage in NY a Medicare Advantage plan (as in your thread title), or was it Medicare Supplement (as in the text of your post)? Please let me know, and I'll reply back with some potential guidance.

Since the title of the thread says that the person moved out of the servcie area on an MA HMO your question was answered before you asked it.

Also, what service area is there to move out of for a med sup?

For the op, you will need the termination letter from the MA plan. It will give the reason for the termination.

 

[Bill_Kiray]

Since the title of the thread says that the person moved out of the servcie area on an MA HMO your question was answered before you asked it.

Also, what service area is there to move out of for a med sup?

For the op, you will need the termination letter from the MA plan. It will give the reason for the termination.

The original poster called the person a "MedSupp client" in the body of their post, while referencing MA in the title. It wasn't a bad question, just a request for clarification.

In terms of service area for MedSupp, there are many carriers that are not available in 50 states. If the consumer was a member of a MedSupp that was available in NY but not in NC, then they would have moved out of the service area for the MedSupp product. Again, a very legitimate question.

One of our agents just had a situation like this happen with MedSupp last week, so that's why I ask to be sure exactly what the situation is before answering.

 

[wehotex]

Med Supp Client moved from NY recently, and when I first met with her, I told her that she would have to notify the carrier of her address change and they would issue an involuntary DE letter because she moved out of the service area. I stressed that in NC this letter is required for her to be GI. She sent me a generic DE letter from the carrier yesterday, incicating voluntary de and no change of service area.

Any of you replacement pros run into this, and how'd you handle it. Just checking to see if anyone knew any cute tricks, this lady has a lot of trouble understanding what is required.

Wouldn't it have worked out better if she had gone through Social Security to change address instead of MA and then SS would have notified the carrier. This would generate a letter from MA stating that she was no longer eligible for coverage due to residing outside of the service area.

 

[bill3173]

For the op, you will need the termination letter from the MA plan. It will give the reason for the termination.

I have the term letter, but it's not the one I need. It is a straight DE letter, that you would get from a voluntary DE during this period. That won't cut it here.

I've handled several of these in the past, and as you indicated, there is always an explanation of the involuntary DE.

Apparently she didn't notify the carrier of her address change. Frankly, I don't know what was said and why, other than she failed to communicate her interest to them.

Kiray, sorry for the confusion, she is a new med supp client to me, but previously MA.
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Wouldn't it have worked out better if she had gone through Social Security to change address instead of MA and then SS would have notified the carrier. This would generate a letter from MA stating that she was no longer eligible for coverage due to residing outside of the service area.

Excellent question, she had notified SS when I met her and hadn't received a thing from the HMO. She had been here for three months at that time. That's when I told her that we had to have the letter, and to notify the carrier directly of her address change, and what followed was what I stated previously: Generic DE Letter.

I know that she's a GI case, I'm just wondering if this is one of those infrequent screw ups. I had a client call me on one the other day(just a little different than this one), that was purely an oversight by the SSA which was caught and corrected after being brought to their attention.

 

[Bill_Kiray]

I've looked at 2 different carriers underwriting guides specific to North Carolina (AARP & Mutual). Both carriers' guidance specifically says that a consumer has GI rights if they were a Medicare Advantage member and move out of the service area. Since this client has moved out of the service area of her previous plan, she simply needs to apply within 63 days of her date of relocation.

Neither carrier has any language in its producer guide to indicate any further condition beyond these. Hope this helps!

 

[jdeasy]

The original poster called the person a "MedSupp client" in the body of their post, while referencing MA in the title. It wasn't a bad question, just a request for clarification.

In terms of service area for MedSupp, there are many carriers that are not available in 50 states. If the consumer was a member of a MedSupp that was available in NY but not in NC, then they would have moved out of the service area for the MedSupp product. Again, a very legitimate question.

One of our agents just had a situation like this happen with MedSupp last week, so that's why I ask to be sure exactly what the situation is before answering.

The person can keep their med sup even if it's not offered in the state they move to. There is not a service area for a med sup.
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I have the term letter, but it's not the one I need. It is a straight DE letter, that you would get from a voluntary DE during this period. That won't cut it here.

I've handled several of these in the past, and as you indicated, there is always an explanation of the involuntary DE.

Apparently she didn't notify the carrier of her address change. Frankly, I don't know what was said and why, other than she failed to communicate her interest to them.

Kiray, sorry for the confusion, she is a new med supp client to me, but previously MA.
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Excellent question, she had notified SS when I met her and hadn't received a thing from the HMO. She had been here for three months at that time. That's when I told her that we had to have the letter, and to notify the carrier directly of her address change, and what followed was what I stated previously: Generic DE Letter.

I know that she's a GI case, I'm just wondering if this is one of those infrequent screw ups. I had a client call me on one the other day(just a little different than this one), that was purely an oversight by the SSA which was caught and corrected after being brought to their attention.

You need the termination from the MA carrier that gives the reason for the termination. Then they have 63 dayus from the date of that termination.

Without that letter then it won't be GI.

 

[bill3173]

Without that letter then it won't be GI.

Yes, I know, and I appreciate your responses. You're the only one that seems to understand the problem. I thought maybe someone had run into this situation and had done something anecdotal to fix it.

It's a straight case of moving out of the service area, and she's spoken to everyone that should have been able to help. Of course, I haven't heard the other side of the conversation. Maybe she said something confusing to the SSA and the carrier.

 

[jdeasy]

Yes, I know, and I appreciate your responses. You're the only one that seems to understand the problem. I thought maybe someone had run into this situation and had done something anecdotal to fix it.

It's a straight case of moving out of the service area, and she's spoken to everyone that should have been able to help. Of course, I haven't heard the other side of the conversation. Maybe she said something confusing to the SSA and the carrier.

I have had the situation where the person lost that termination letter. It was a simple matter of calling the terminating company while with the person and just telling them that it was lost and we need a new one. They have always complied. They just don't get in a hurry. It takes a couple of weeks to get the new letter. If you are bumping up against the 63 days then maybe you could get them to fax or email it.

I have also gone ahead with the med sup application when faced with that deadline and then when they med sup company they stopped the process until I could provide the letter. That's a PITA but it kept the person from missing the deadline to apply.

I remember one where time was of the essence so I just went through the underwriting because I thought there was no issue. This was one where they did the phone interview and gave an answer. There was one med the lady "forgot" to tell me about that caused it to be declined. I told the company about the situation and that she was waiting on a replacement letter about the termination. They said they hold it open until we got the letter. They did and once we finally got the letter she got her policy.