Finding a solution for Agent error on MA app

[wehotex]

I know an agent who completed an online app with an applicant, but neglected to key in the option to enroll into the Dual plan. Now, this member has been enrolled into a non-Dual plan and needs to be enrolled RETROACTIVELY back to the effective date of the app. I know that the mb may use an SEP to start the Dual plan for the 1st of next month, yet mb wants the retroactive date instead. My coworker says that the member could complain to the MA carrier and ultimately get the retroactive date, but that would result in an allegation to the writing agent- OUCH. Is there a solution?

 

[policywunk]

I know an agent who completed an online app with an applicant, but neglected to key in the option to enroll into the Dual plan. Now, this member has been enrolled into a non-Dual plan and needs to be enrolled RETROACTIVELY back to the effective date of the app. I know that the mb may use an SEP to start the Dual plan for the 1st of next month, yet mb wants the retroactive date instead. My coworker says that the member could complain to the MA carrier and ultimately get the retroactive date, but that would result in an allegation to the writing agent- OUCH. Is there a solution?

 

[policywunk]

If they call medicare they may be able to dis enroll them but IMO it is very unlikely they will change their plan retroactively unless the member claims its was a fraudulent application by the agent.

 

[WCMason]

I know an agent who completed an online app with an applicant, but neglected to key in the option to enroll into the Dual plan. Now, this member has been enrolled into a non-Dual plan and needs to be enrolled RETROACTIVELY back to the effective date of the app. I know that the mb may use an SEP to start the Dual plan for the 1st of next month, yet mb wants the retroactive date instead. My coworker says that the member could complain to the MA carrier and ultimately get the retroactive date, but that would result in an allegation to the writing agent- OUCH. Is there a solution?

I have a downline agent who mistakenly checked wrong box on a Humana MA app and put the beneficiary in an MA with no PD. She contacted them and was sent a form used for corrections. Original enrollment was changed to the intended MAPD plan retroactively. Carrier policies obviously may vary, but apparently CMS must allow it.

 

[fun2drum]

I have a downline agent who mistakenly checked wrong box on a Humana MA app and put the beneficiary in an MA with no PD. She contacted them and was sent a form used for corrections. Original enrollment was changed to the intended MAPD plan retroactively. Carrier policies obviously may vary, but apparently CMS must allow it.

Yes I can verify that, at least for Humana. I was a Humana career agent for 13 years until I went delegated early this year. I did one of those forms a couple of times over my career. What it amounts to is an emailed statement that you made an error by putting abc on the application and what the member really wanted was xyz. Nothing ever comes back to bite you and the member gets what he/she wanted. I'm honestly not sure what the process is for delegated agents but it would be easy enough to find out.

 

[fishfortwo]

It is the same for delegated agents as well with Humana. They can call agent support an walk them through.

 

[JaBrooklyn]

If they are dual or LIS, sometimes you are better off just submitting a second app and praying for a healthy month.

Depending on the company.....If the call goes to India, you are in trouble...