Marketplace Navigators Changing Clients Plans

[bill3173]

You can't control the messaging when the marketplace sends constant emails, mailings, and robo-calls notifying them of a message in their account, wrong 1095's, password resets, or follow up on document submission.

The client is more afraid of the gov't than they are of losing your relationship.

Had a lady call me today that was audibly shaken by all of the letters emails and other stuff that she received concerning her tax filing for last year. She was very sweet, but also sounded "scared".

I don't think a birthday card from an agent or a "checking in with you" phone call means a whole lot these days for "on-ex" clients.

I'm scared to death of the Government as well. Heck, I'm even scared of the carriers...if you're suspected of a CMS violation, it makes you feel like you're under Pinochet's rule.

 

[somarco]

Obamacrack police are watching you, Bill.

https://www.youtube.com/watch?v=OMOGaugKpzs

 

[tonyisme]

How appropriate and accurate and that was a great concert back in the day.

 

[MaryDallas]

This happened a few times this season with my clients as well. Now what I have the client do is call and have me put on their file as an authorized person for one year (the maximum time period allowed), and then I call in the changes myself. Do I like doing even more work? No. I like even less to lose business.

One of my clients was just calling in a change of address and the navigator did the same thing...actually said, "Did you know you can change to BC/BS for $1 less?" The client said, "Okay." He then called me and said, "I think I just messed up." It took me three days to get it straightened out. And yes, I called and reported it to a supervisor and told the supervisor that I was going to report every one of these from now on. [I simply tell the clients some of the navigators have changed health insurance on some of my clients to their detriment.]

Also, I got appointed with every carrier just in case this happens and I can turn in an AOR. I've had to do that a few times as well.

 

[houcoogster]

This happened a few times this season with my clients as well. Now what I have the client do is call and have me put on their file as an authorized person for one year (the maximum time period allowed), and then I call in the changes myself. Do I like doing even more work? No. I like even less to lose business.

One of my clients was just calling in a change of address and the navigator did the same thing...actually said, "Did you know you can change to BC/BS for $1 less?" The client said, "Okay." He then called me and said, "I think I just messed up." It took me three days to get it straightened out. And yes, I called and reported it to a supervisor and told the supervisor that I was going to report every one of these from now on. [I simply tell the clients some of the navigators have changed health insurance on some of my clients to their detriment.]

Also, I got appointed with every carrier just in case this happens and I can turn in an AOR. I've had to do that a few times as well.

This is a classic textbook case of "a little knowledge is a dangerous thing".

 

[Sherota1]

Were any of you call a liar in other words by the Marketplace. The same things have happened to me. My client call the Marketplace to ask a question about Medicaid. They looked him up in the system and submitted an application with the wrong information. He needed to make some changes for 2015. When we called back to have the application terminated they not only terminated it but removed the application. The problem is now the application does not exist. It reached the carrier and they insist that he pay the premiums which he cannot afford. They have escalated the case twice and did an advance resolution twice.No solution found. In the end they said they are not saying that I am a liar but it most likely was one of us me or my client that terminated the application but it definitely was not someone at the Marketplace.
One thing I'm glad of is that for some reason I always take screen shots of the plans from my clients account and send it to them. I was able to look up my clients account from my web broker portal and download his eligibility letter and take a screen shot of the plan that they enrolled him in. I do this for all of my clients who lack computer skills or do not have internet access.
I finally got an address out of the rep where I could send in proof of the deleted account. To date the problem is unresolved.

 

[Zanetti90]

Were any of you call a liar in other words by the Marketplace. The same things have happened to me. My client call the Marketplace to ask a question about Medicaid. They looked him up in the system and submitted an application with the wrong information. He needed to make some changes for 2015. When we called back to have the application terminated they not only terminated it but removed the application. The problem is now the application does not exist. It reached the carrier and they insist that he pay the premiums which he cannot afford. They have escalated the case twice and did an advance resolution twice.No solution found. In the end they said they are not saying that I am a liar but it most likely was one of us me or my client that terminated the application but it definitely was not someone at the Marketplace.
One thing I'm glad of is that for some reason I always take screen shots of the plans from my clients account and send it to them. I was able to look up my clients account from my web broker portal and download his eligibility letter and take a screen shot of the plan that they enrolled him in. I do this for all of my clients who lack computer skills or do not have internet access.
I finally got an address out of the rep where I could send in proof of the deleted account. To date the problem is unresolved.

*****
I had a similar situation last year. Client wanted to switch plans.She is bipolar....
Called marketplace in front of her and told her do what you want with the plan. Did new application,new app id. She wrote down everything . Called month later plans did exist. Even her previous plans got canceled .Client super pissed but thank god she talk to marketolace or i would had an e&o claim.

 

[MaryDallas]

I have not been called a liar, however, I have been hung up on quite a few times. There seems to be 'the great divide' between brokers and navigators. We seem to have new enemies. Every once in a while I will get someone knowledgeable and helpful. The unit out of Utah seems to be the better team. Too bad we can't ask to forward to the Utah unit. One navigator told me they weren't allowed to say where they are located because they might get bombed. Some of their comments are most inappropriate.

 

[Norwayguy]

I have not been called a liar, however, I have been hung up on quite a few times. There seems to be 'the great divide' between brokers and navigators. We seem to have new enemies. Every once in a while I will get someone knowledgeable and helpful. The unit out of Utah seems to be the better team. Too bad we can't ask to forward to the Utah unit. One navigator told me they weren't allowed to say where they are located because they might get bombed. Some of their comments are most inappropriate.

With how "well" they are doing they just might have a legitimate concern.

 

[sunkarma11]

To date the problem is unresolved.

call the CMS regional offices.. I had a case last year that took 10 months to clear up

to spare you several pages of gory, familiar, and boring details... Long and short - I had a client that had to be submitted/escalated several times because information on the application kept falling off (half the family) by the time it got to the carrier which rendered subsidies incorrect, and premiums incorrect, etc. Started in January and finally got a correct application to the carrier for a June 1... only problem was they cancelled her for non-payment in August; they took the payments she made and applied them to the prior incorrect applications... so she did not have coverage in June when her hubby went in the ICU for several days... good times.

I was able (a few months into it) to determine CMS had not provided guidance on how to "null" an invalid plan so the carrier thought they were owed for plans that were not valid and could not have been accessed and thus were swiping payment. Learned that several hundred people were in the escalation loop for the same thing... the marketplace escalation rep let slip about the CMS regional office oversight.

I tracked down the number for the regional office, reported the problem (had to have the client handle call backs - CMS wouldn't talk to me... ) I was able to get them to investigate, and they got her plan re-instated back to June using the payments already applied, got her meds (family took a ton of them) re-imbursed for having had to pay out of pocket, got her hubby's 60k ICU bill covered for her original 500 deductible/ 750 MOOP... call them... see how fast that gets fixed...