LEP for Prescription Plan

[steveadlman]

I have a client that has called her prescription drug plan twice to inform them she has had credible drug coverage since turning 65. Despite the phone calls, the drug plan has assessed her a late enrollment penalty of $21.20. She has even mailed them the required information. What is her remedy to get this fixed?

 

[vic120]

Needs to submit LEP appeal form with Maximus

I would post pdf the attach button is not working though

 

[Midlevel]

Keep calling the carrier until you find someone who can actually put a sentence together and sounds like they may be able to help and then tell them the situation and have them check into it and hopefully get it corrected. Also, if you have a relationship with a regional sales manager for the Company I would contact them and get them involved also. If you absolutely can't get anywhere you will need to file an appeal to try and get it removed. I believe the forms are on ssa.gov site.

 

[vic120]

Keep calling the carrier until you find someone who can actually put a sentence together and sounds like they may be able to help and then tell them the situation and have them check into it and hopefully get it corrected. Also, if you have a relationship with a regional sales manager for the Company I would contact them and get them involved also. If you absolutely can't get anywhere you will need to file an appeal to try and get it removed. I believe the forms are on ssa.gov site.

Once its been charged its in Maximus hands no longer the ins company had to deal with it 2 X once just last week

Both times they never got notice request for info

 

[Midlevel]

Not always, if you get someone that knows what they are doing like a Sales Manager and they see they sent in the required documents and someone just didn't enter it properly they can still let Medicare know they shouldn't have the penalty. Good luck with Maximum, may be a long process.

 

[DS4]

• If you disagree with your late enrollment penalty | Medicare

 

[vic120]

Not always, if you get someone that knows what they are doing like a Sales Manager and they see they sent in the required documents and someone just didn't enter it properly they can still let Medicare know they shouldn't have the penalty. Good luck with Maximum, may be a long process.

The first time I went through this was an Aetna plan like 5 or maybe 4 years ago, Got FMO involved

Spent tons of time getting it up the ladder to finally (after nearly a month back and forth arguing) get the answer once it is charged it's out of Aetna's hand and you have to deal with Maximus

That only Maximus can overturn a discision

 

[TwoCents]

FYI -- As of 2/1, the Part D LEP appeals go to C2C. Maximus is out of the picture.

OP isn't giving us a full picture. When did the client start Medicare? Is this the first time being enrolled in a Part D drug plan (PDP or MAPD)? Did the carrier send a letter requesting info or did they just send a letter saying "your premium reflects an LEP" which would mean a prior carrier assessed the LEP so the current one won't touch it with a 10-ft pole.

C2C Forms: Enrollee/Appellant Forms