If Proposed Member Wants to Cancel, who Should He Call?

wehotex

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Houston, Tex
One of my members frantically called me to say that he was switched to United Health Care. Funny thing is, he doesn't speak any English, very quiet, doesn't have a phone and didn't sign anything (or so he says). I looked up the agent on the DOI website. He only started selling MAs in late January. My member was enrolled in the first week of February. He wants to cancel that app. Would you call 1-800-medicare or UHC to cancel the app?
 
He should call both and have Medicare investigate the agent.

Rick

Good idea. That's what we'll do.

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He should call both and have Medicare investigate the agent.

Rick

I just completed the calls. What a circus that was! The UHC rep merely took down the info and put in the request. Didn't take long. He didn't ask any digging questions like "why?" Or if he wished to file a complaint, etc. kinda disappointing. The last allegation that I received bak in 2008 from Humana was a "phishing expedition" with the Cust services rep making it into a full blown allegation, where there was no basis.
The Medicare call was a disaster. They wanted so much information to verify from the deaf, non-English speaking illiterate man. It took forever. His friend (also my customer) did not want to "press charges". They are mild mannered ppl and probably didn't want someone calling the man. Anyway, it looks like it will be cancelled before it was supposed to be effective.
 
The UHC call should have been easy since they can't do anything to persuade him to stay a member and being before the effective date is exactly when he needed to call. As far as investigation, it is what it is.
 
Good idea. That's what we'll do.

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I just completed the calls. What a circus that was! The UHC rep merely took down the info and put in the request. Didn't take long. He didn't ask any digging questions like "why?" Or if he wished to file a complaint, etc. kinda disappointing. The last allegation that I received bak in 2008 from Humana was a "phishing expedition" with the Cust services rep making it into a full blown allegation, where there was no basis.
The Medicare call was a disaster. They wanted so much information to verify from the deaf, non-English speaking illiterate man. It took forever. His friend (also my customer) did not want to "press charges". They are mild mannered ppl and probably didn't want someone calling the man. Anyway, it looks like it will be cancelled before it was supposed to be effective.




Was it a forged paper or Ienroll signature or did agent trick him in to signing paper or Ienroll application without realizing it was an enrollment application? Of course if agent entered application himself on www.mymedicareenroll.com that is considered fraud even if consent to enroll is given by consumer.

hard to believe UHC didn't want to escalate it considering it's fraud on an illiterate deaf person with a language barrier.According to CMS guidelines agents are required to bring a sign language interpreter if meeting with a deaf person and cases of language barrier there is suppose to be a translator that either the consumer or agent provides.When enrolling an illiterate person an agent should advise the consumer to have a trusted adviser present to verify what you are telling them is actually in writing.Wow this person seems almost impossible to enroll in in a MA plan compliantly even if they give consent!
 
Was it a forged paper or Ienroll signature or did agent trick him in to signing paper or Ienroll application without realizing it was an enrollment application? Of course if agent entered application himself on www.mymedicareenroll.com that is considered fraud even if consent to enroll is given by consumer.

hard to believe UHC didn't want to escalate it considering it's fraud on an illiterate deaf person with a language barrier.According to CMS guidelines agents are required to bring a sign language interpreter if meeting with a deaf person and cases of language barrier there is suppose to be a translator that either the consumer or agent provides.When enrolling an illiterate person an agent should advise the consumer to have a trusted adviser present to verify what you are telling them is actually in writing.Wow this person seems almost impossible to enroll in in a MA plan compliantly even if they give consent!


LOL- The man wasn't completely deaf, but very hard of hearing. If the enrolling agent also spoke Spanish, it's not an allegation. I don't know how the man got on the plan. It's a shame that they didn't want to know either. I think that the friend was worried that they would interrogate the man even further ad make more work for her.
 
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