OEP exceptions

Feb 19, 2008

  1. fostever

    fostever Guru

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    Has anyone run into an existing client like this: Two of my existing clients were approached by one of our former MA agents and signed them up under false pretences. He said he was still with our company and needed to sign them up for additional benefits and flipped them to his new MA plan. He did this on his lap top and had them sign an electronicly without showing benefits except the extras. This was near the end of January making their effective date Feburary 1. They recieved a notice that they would be billed monthly $22.80 for the part "D" portion when it used to be zero. They were pissed because he didn't mention the part "D" premium or that it was a new company. I told them that due to CMS rules they have one plan change per OEP unless they were LIS or duel. They called the new plan and are in the process of disenrolling. Since this agent flat out lied to them, do they need to file a grevience with Medicare to get back in their old plan. The new plan said to state that they wanted to continue with their old plan on the DE letter. They did that today through a fax. I know all insurance policies have a 20-30 day free look period but CMS rules trump that as far as I know. Has anyone had a similar situation. We tried calling Medicare but the estimated wait time was 15 minutes. I think CMS would have to make an exception in these types of cases. Any thoughts?:arghh:
    fostever, Feb 19, 2008
  2. retread

    retread Guru

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    Absolutely! CMS came out with a special enrollment period last summer for beneficiaries duped by unscrupulous agents for situations exactly like this. Your MA enrollment application should have this stated somewhere with a box to check or at least an enclosed REQUIRED form for those so affected to allow them to qualify for that SEP.
    retread, Feb 19, 2008