How to Get a Carrier to Refund a Med Supp Premium to an MAPD Member

Jul 2, 2015

  1. WCMason
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    WCMason Guru

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    So a guy calls me regarding his mother's increasing Medicare supplement premium. She's a retired teacher and years ago took a Medicare supplement out with United Teacher Association. After asking him a few questions found out that a couple of years ago she got enrolled--has no idea how--in a Teachers Retirement System Medicare Advantage plan (this is in Texas). So I explain to him that she can't have--and doesn't want--a med supp and MA plan and should contact the med supp company about a refund of premiums back to the date of the switch.

    UTA confirms they have paid no claims since the MA enrollment despite her having lots of health problems. At first they told the son that their policy was to refund only one year. He appealed that to a supervisor and is now being told no refund is due because they were at risk during that time, a ridiculous claim.

    I had a similar situation to this happen a few years ago with New Era and they immediately refunded 3+ years in premiums (nearly $5,000) as soon as they got proof of the MA enrollment. UTA appears not to be so cooperative. Any suggest possible options for this son to get his mother some money back?
     
    WCMason, Jul 2, 2015
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  2. somarco
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    somarco That Medicare Expert Guy

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    I suspect this is carrier specific.

    New Era had no problem refunding 17 months premium on a Medigap plan I wrote when the guy decided a few months later to pick up a $0 plan. Of course they had not paid any claims during that period because the MA was primary, not Medicare.

    I don't know if the DOI will be any help or not. There may or may not be anything in the policy about premium refunds.

    Most health insurance carriers (non-Medigap) limit refunds to 12 months but if pressed I have seen situations where they exceeded that limit.

    Of course the obvious question is, didn't she notice premiums coming out of her account over the last 3 years?

    You can certainly appeal it up the food chain at UTA. I don't know if anyone at CMS will have an interest in this or not but there might be a pesky news reporter that is interested in a story about a retired school teacher that is being robbed by a big bad insurance carrier.
     
    somarco, Jul 2, 2015
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  3. margostl
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    margostl Expert

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    So I'm bumping this old thread because I have something similiar happen.The client's wife called and stated that he decided to switch in December to MA from Medsupp different carrrier.He called in and after enrolling asked if he needed to cancel the Medsupp.The agent told him no that the MA would cancel it out.3 months later of course the payments are still coming out of her account,( she's also a client )could I please handle it. I stated I would but I would have to become the AOR since I'm out of the Loop when he made the call.In the process now of writing an appeal letter to become AOR.Who should refund the premium the company that gave the misinformation or the Medsupp carrier who continued to take prem.? The spouse is a former Life Agt. so he knew to ask about cancellation of Medsupp.His problem was he blindly trusted the agt knowledge because he was calling in house.
     
    margostl, Mar 11, 2019
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  4. vic120
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    I had Aetna hit me with a chargeback for like 10 months, Had a client I signed up for med supp had MA plan through work I told her to cancel but she calls me the following oct said she got hops bill and Med Supp won't pay After checking she never canceled MA, So she called supp instead and got all her premiums back
     
    vic120, Mar 11, 2019
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  5. russelltw
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    I would think it's time for the DOI to step in.
     
  6. TwoCents
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    TwoCents Guru

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    I don't think the MA is going to have a petty cash account to repay premiums paid to another carrier for the supp. You're best bet is to try to get the supp retro termed back to when the MA started.
     
    TwoCents, Mar 11, 2019
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  7. sshafran
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    sshafran Guru

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    I don’t understand how AOR fits into this. You’re trying to become AOR on the med supp policy that is being cancelled? Why on earth? Or the new MAPD policy? (which would have no bearing on getting premium refunded).

    Before I would do anything, I would tell him that he simply needs to call his old med supp carrier and cancel, requesting the cancellation effective 1/1/19 (edit: 12/31/18 end of day). See what they say. Instruct him to explain, mapd started 1/1.

    I would not tell my client (his wife) that I would handle this for him. I wouldn’t even tell my client that I would handle his cancellation - they need to cancel their policies.

    Maybe I’m doing it wrong, but no, I don’t handle their cancellations - they do.
     
    sshafran, Mar 12, 2019
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  8. somarco
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    somarco That Medicare Expert Guy

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    I don't "handle" cancellations either, Scott. Even with existing clients, changing from one Medigap carrier to another. I email specific instructions on how to cancel their existing plan and when to do it.

    Most of the time they do as instructed, but every once in a while they fail to cancel the inforce plan and end up double paying. When that happens I try to get the new carrier to change the effective date to a month later. I only have one carrier that refuses to change the effective date without a new application.

    Really?
     
    somarco, Mar 12, 2019
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  9. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    I do it for them, only I don't cancel. I stop the bank draft and tell them to just ignore the premium notices and it'll cancel itself. That way if something goes wrong, I can always get them back on bank draft. I do this at the time of the sale. That way I know it gets done and when they sign the letter stopping the bank draft, they're making an extra commitment to what they just bought. Also gives less time for their former agent to react before mine is delivered and in force.:yes:
     
  10. sshafran
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    Same here - I have a "template" e-mail that I send out for each new app that gets approved and issues. It covers all scenarios:

    - mapd to mapd - reminds them that they don't need to do anything, it'll automatically switch over
    - pdp to pdp - it'll automatically switch over, no action needed...
    - mapd to med supp + pdp - same as above
    - med supp to med supp - instructions to call and cancel old med supp

    I wrote this template out last year during AEP because I kept typing the same thing over and over, so I made a canned response. I simply erase 3 of 4, and keep the 1 scenario that applies. Each "template" also has things in there like new company name, effective date, and a reminder that they'll receive their new card (usually) within the next 15-20 days.
     
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