Enrolled in MA - Big Mistake

[goillini52]

Back on track . . . .

Talked with the couple earlier and they don't want to press the issue. They claim they were confused and not the fault of the agent. (They now say it was an agent, not the carrier).

Plus the man had hip surgery and complications a couple of months back. His OOP (according to him) is $10,000.

Still don't know if the agent pulled a fast one or they missed something.

This really bites.

Since they can't make up their mind whether it was the company or an agent, I'll go with they missed something. But then the agent might have gone back in and purposely confused them if he pulled a fast one.

Oh well, you tried.

 

[LostDollar]

Back on track . . . .

Talked with the couple earlier and they don't want to press the issue. They claim they were confused and not the fault of the agent. (They now say it was an agent, not the carrier).

Plus the man had hip surgery and complications a couple of months back. His OOP (according to him) is $10,000.

Still don't know if the agent pulled a fast one or they missed something.

This really bites.

Did you ever get far enough in conversations for them to tell you if they knew whether or not they'd had an MAPD before so you might be able to do something for them before AEP without them having to make any fuss about agents or carriers? I'd think they'd be interested in attempting to avoid the possibility of another oop like that between now and October.

(ie, Mr and Mrs client, if you qualify for this exception, you won't have to COMPLAIN and upset anybody about anything, all you have to do is submit an application.)

(I haven't had a MyMedicare account long enough to know if the plans and coverage tabs show only current plans or plan history as well.)

 

[goillini52]

Did you ever get far enough in conversations for them to tell you if they knew whether or not they'd had an MAPD before so you might be able to do something for them before AEP without them having to make any fuss about agents or carriers? I'd think they'd be interested in attempting to avoid the possibility of another oop like that between now and October.

(I haven't had a MyMedicare account long enough to know if the plans and coverage tabs show only current plans or plan history as well.)

I thought he said that they couldn't remember.

 

[LostDollar]

I thought he said that they couldn't remember.

I can't remember what they can't remember.

 

[goillini52]

I can't remember what they can't remember.

Unfortunately, I know what you mean.

 

[somarco]

I didn't ask a lot of questions initially. Seems the more I asked the more frustrated they became. It was hard to do a forensic evaluation and really pointless without their cooperation and documentation.

When I got back with them and discovered the hip surgery I figured it was pointless to go delve further. They weren't real happy when I said this may take a while to unravel and it would be complicated by the missing pieces (documentation).

You can't win every time. Sometimes you need to cut bait.

That's what I did.

Don't need another hobby.

 

[YouGotMyMoney]

Yes, have them complain to CMS, saying the agent lied to them. CMS will investigate the agent, give him a Section A violation, and Grant the old people an SEP. The process should take 3-6 months, depending on how much the agent fights back.

Whoaaa...

Damn forget all that, just let them wait till AEP/OEP.

 

[LostDollar]

Whoaaa...

Damn forget all that, just let them wait till AEP/OEP.

Whoa yourself. If an agent wants to help someone in that situation, it is not your place to say they can't.

 

[bekahsack]

Got a call from a couple. Late 70's. Told me that "someone from Humana" called late last year and "upgraded" their coverage . . . from a supplement to MA."

Sounds like you're not pressing the issue any further with them, but I do have one comment.

I'm certainly not an expert on MA compliance, but from what I remember, you can't just call a client and pitch MA. The client has to mention it first or establish contact themselves. I'd think you could report this to CMS as a compliance violation at the very least...

 

[GreenSky]

Sounds like you're not pressing the issue any further with them, but I do have one comment.

I'm certainly not an expert on MA compliance, but from what I remember, you can't just call a client and pitch MA. The client has to mention it first or establish contact themselves. I'd think you could report this to CMS as a compliance violation at the very least...

That holds true for agents. But if a company has the PDP they can pitch them anything they want.

Rick