OEP-PDP Issue please read and help!!

[Fishtoe]

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

 

[moonlightandmargaritas]

And before you tell me to call CMS...I have...after a 40 minute wait I gave up.

This should certainly be an interesting point for all of the proponents of single payor, government sponsored, universal health care coverage.

 

[Guest]

This should certainly be an interesting point for all of the proponents of single payor, government sponsored, universal health care coverage.

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

Al

 

[moonlightandmargaritas]

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

No doubt, but how does it improve the situation?

 

[GreenSky]

No doubt, but how does it improve the situation?

It doesn't but as usual, he must point out how much he hates insurance companies.

What do you expect from a socialist?

Rick

 

[senior-advisor-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.

 

[scottfree]

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....

 

[MedSuppPro]

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.