OK, let me know what you guys think of this situation. I have an ex-GM employee and spouse. They were losng coverage through GM,coverage ended 12-31-08. They choose a Humana MAPD effective 1-1-09. They contacted me in late January wanting to change plans. I moved the husband to a Coventry MAPD, no problem. I called around and determined that MOO would take the wife into a Medicare Supplement PLan F and wrote her up on Coventry stand alon PDP. I was a little unsure of moving the wife to a Med Supp/PDP as my understanding was she could only make one SEP election. However, MOO and COventry both told me as long as she was in the 60 day SEP window they ha no problems. Here is the porblem, Humana refuses to disenroll the wife from their plan and now no one is paying claims. I should note that I went with Feb, 09 effective dates. She has seen doctors in MArch already and no one is paying claims, I think because CMS still has her enrolled with HUmana.. Any thoughts on why HUmana refuses to disenroll her? Who do I call first to get this mess straighted out. I will admit that the client is confused and I am going to their house tomorrow am to see if I can assist them. Thanks in advance for any input.
SEP Question
- Thread starter golfnut
- Start date
- 19,647
The problem is that she is not disenrolled from Humana. Everything else, according to the inforamtion given, is OK. There is no reason for not being disenrolled from Humana. This one you will have to take up with Medicare. They will force Humana to do a disenrollment. The enrollment into the PDP should have kicked out the Humana. It may as easy as making a call to Medicare. Sometimes it takes more labor intensive involvement.
- 2,370
Since this was her first enrollment in a MAPD plan, she has a SEP to move to a stand alone PDP and orig Medicare anytime. Sometimes you have to remind Medicare of that.
- Thread starter
- #4
Yes I am thinking a call to Medicare is what is needed as well. The Client has stated that she called Medicare and they told her Humana has to advise them of disenrollment or MOO send Medicare a letter stating she enrolled into a Med Supp. As stated, I would think the PDP move would have moved Humana out of the picture, but Client advised me she has not received member card from Coventry,but Coventry has her active in their system. I think some of the trouble as that the Client paid for Humana for Jan. and Feb in advance, why I have no clue. This really points out that not amny people working for the insurance Companies or Medicare really know the rules! Just us little agents that have all the responsibility.
- 148
Your problem doesn't lie with Medicare or Humana. It lies with Coventry. Make sure Coventry's enrollment has the application and is processing it. Do not bring Medicare into this as they will fix everything, and you will lose all commissions as well as you will no longer be the agent of record. When Coventry's enrollment dept. does their job, Medicare will follow through and disenroll Humana.
- 1,240
You can call Coventry at 888-736-0486. This is a special # I was given for issue problems. You get right through and the person I spoke with was very knowledgeable. I explained the SEP to them and they fixed it right away. I hope you have the same luck 
