I have a HUGE problem, How do i fix this? no coverage!

Discussion in 'Senior Insurance Forum' started by senior-advisor-indiana, Mar 23, 2007.

  1. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    I met a couple who was with pyramid on a medicare supplement. They wanted to switch to get a lower premium. The husband couldn't quailify. So i wrote her a new policy and cancelled hers. Well a month later i get a phone call from the client saying her husband's policy lapsed.... he has HIV!

    I called pyramid and they said that It was one policy with the husband as the dependent. So when she cancelled hers it cancelled both. He had a surgery that is unpaid. Is there anything i can do? I did sign him up on a MA plan yesterday so that i can switch him to a med supp in 2 months with no health questions.

    The Problem is that the agent that wrote the policy wrote the husband as a dependent. How can they make the husband drop his policy? what if she died, or they got divorced. I hope i can do something because i am at fault to for assuming that he would be able to keep his policy. I have never ran into this EVER! I have never had a cmplaint against me either. I'm not a scammer i really am there to help people and I was trying to do the right thing.
     
  2. johnrocks
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    was the surgery done when the policy was in force if so nothing to worry about
     
  3. senior-advisor-indiana
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    No, they cancelled feb. 1 and the claim was end of feb. beginning of march.
     
  4. Crabcake Johnny
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    So again, to be crystal clear, the husband had no in-force coverage at the time of the surgery? You're saying they had formally cancelled the plan and they the surgery occured?
     
  5. johnrocks
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    undoubtly when this happened you were still captive so i would take this matter to them and there legal experts this is why E&O is such a good idea.once I unraveled myself from this i think that i would separate myself from this headache. i remember that i got into a little tit for tat once simaliar to this and i called the Louisiana Department of Insurance and asked to talk with someone in the legal department and he told me that the responsibility of a cancelled policy is with the client not the agent. you can't cancel the policy they had to so maybe your not to be blamed
     
  6. senior-advisor-indiana
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    Yes. He had the surgery, He hasnt even got the EOB yet from medicare. They way they found out he was cancelled was he had a dr. visit feb. 17 and in The EOB (explanation of benefits) it said no payment due to lapsed policy. I called pyramid and they said it lapsed because the wife cancelled her policy. I have never ran into this with medicare supplement policies.
     
  7. senior-advisor-indiana
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    Maybe legally i'm not to blame but I feel I am because they put thier trust in me to help them out. I am suppose knw these things. I guess in the future I will now. But the client did call and cancel herself.
     
  8. johnrocks
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    I've talked to you and sense that you are a very moral and ethical young man, but it just goes back to CYA(cover your ass) and if that still doesn't do it subsitute carry for cover!
     
  9. Crabcake Johnny
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    It doesn't sound like anything malicious was done - just a lot of bad communication. When the wife cancelled her policy she should have made sure her husband could remain on the plan. On your end you just assumed this would be easy - wife moved onto another plan and husband stays with what he's got. You only would have had a legal nightmare on your hands had you recommended for some reason that the husband cancel his plann - which you did not.

    Unfortunately this might end up getting ugly. Depending on the cost of the surgery the wife might say "Hey, someone's paying this and it ain't gonna be me."
     
  10. Guest
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    Rule #1: NEVER cancel an applicant's health insurance for them.

    Rule #2: ALWAYS tell the applicant to keep their policy in force until they receive confirmation of coverage under the new policy.

    There is no such thing as a dependent under medicare supplement policies. Pyramid's application does not have dependent mentioned on it. It has a section for applicant and spouse. BUT they are still treated as separate applicants, which is why they pay an individual premium and also why they each have to answer the health questions. They also should have separate policy numbers.
    How did you cancel their policies? Did you call or do it in writing?
     
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