Hospital SEP?

[MedicareWAA]

Just so you know, CMS can issue an SEP to anyone and for any reason. I say that because if someone has a tough story and they manage to find a sympathetic government employee, that employee will often grant what the person is requesting. I’ve seen it often, sometimes just because the beneficiary was a mess.

 

[rmhaire]

Just so you know, CMS can issue an SEP to anyone and for any reason. I say that because if someone has a tough story and they manage to find a sympathetic government employee, that employee will often grant what the person is requesting. I’ve seen it often, sometimes just because the beneficiary was a mess.

Yep.

There's actually a code for this but it's been awhile since I've seen it.

And just because it's not mentioned on medicare.gov doesn't mean there's not one.

There's a lot of gray area when dealing with medicare. Websites and courses don't come near to covering them all.

 

[somarco]

FWIW . . .

If your Medicare hospital is no longer in network, you would typically use a "SEP code" related to "change in provider network" when enrolling in a new Medicare Advantage plan during a Special Enrollment Period (SEP) to switch plans and access a different network that includes your preferred hospital; the specific code might vary depending on your plan and state, but often includes terms like "network change" or "provider change"; it's best to contact your Medicare plan directly to confirm the exact code needed for your situation

AI response to "medicare sep codes hospital no longer in network"