OEP-PDP Issue please read and help!!

Apr 12, 2008

  1. Fishtoe
    Offline

    Fishtoe New Member

    Posts:
    3
    Likes Received:
    0
    I wrote a client on 3/29 ...OEP... for a 4/1 effective date. MAPD to MAPD.
    No problem so far. A couple of days ago the client called me and said "Hey...I just found out that the $2200 I spent on PDP drugs from 1/1/08-3/15/08 (pervious plan) will not transfer to the new 4/1/08 plan"... I have spent a couple of hours trying to find this client some written evidence that his YTD OOP drug cost will be credited to the new 4/1/08 plan. He and I are very concerned that his OOP costs will have to start over!! I was trained that drug costs carry forward but maybe they don't when you use the OEP?? And before you tell me to call CMS...I have...after a 40 minute wait I gave up. Also I have called the company but received conflicting answers. With all the brain power and knowledge on this site I know I call get the correct answer. If you have something in writing please direct me to it.

    THANKS VERY MUCH

    Fishtoe
     
    Fishtoe, Apr 12, 2008
    #1
  2. moonlightandmargaritas
    Offline

    moonlightandmargaritas Guru

    Posts:
    9,749
    Likes Received:
    31
    State:
    Florida
    This should certainly be an interesting point for all of the proponents of single payor, government sponsored, universal health care coverage.
     
  3. Guest
    Online

    Guest Guest

    Try calling Anthem at 9 AM on a Monday morning.... or Aetna anytime of day!

    Al
     
    Guest, Apr 12, 2008
    #3
  4. moonlightandmargaritas
    Offline

    moonlightandmargaritas Guru

    Posts:
    9,749
    Likes Received:
    31
    State:
    Florida
    No doubt, but how does it improve the situation?
     
  5. GreenSky
    Offline

    GreenSky Guru

    Posts:
    15,340
    Likes Received:
    446
    State:
    Nevada
    It doesn't but as usual, he must point out how much he hates insurance companies.

    What do you expect from a socialist?

    Rick
     
    GreenSky, Apr 12, 2008
    #5
  6. senior-advisor-indiana
    Offline

    senior-advisor-indiana Guru

    Posts:
    11,250
    Likes Received:
    162
    State:
    Indiana
    I have never switched someones PDP in the OEP but I was told that the costs carry over. That was from CMS 2 years ago. But of course everytime you call you get a different answer.
     
  7. scottfree
    Offline

    scottfree Super Genius

    Posts:
    149
    Likes Received:
    0
    It will carry over. Although it may take some time. They more than likely will just have co-pays until the plan get info fom Medicare. I had this happen to a client a while ago but they were actually hoping that it wouldn't carry over because it would have kept them out of the gap altogether. I can't remember exactly how but it did get worked out. Not really much you can do to help the situation either.

    Good luck....
     
  8. MedSuppPro
    Offline

    MedSuppPro Guru

    Posts:
    1,214
    Likes Received:
    0
    I agree with Scottfree -- The new carrier will find out. Remember this is a Medicare Plan. It may take the new carrier awhile. I had a carrier in January go back to 2006 and of course both clients asked for some wine to go with their cheese.
     
Loading...