Strange PDP Issue

[vic120]

I have a client that has Med Supp and PDP with me he lives in PA but does go to NY a lot and get's medical in NY (has health issues) becuase h gets good care in NY However he does live in PA Does Tax there Owns home there

He received a letter from PDP ( he has been on the same PDP for 3 years) The Letter states that they will discontinue his Drug cov next year as of 02/20 due to the fact that their records show he moved outside the service area

HUH I had him forward the letter and yes that is what it says Yes it says their records show he moved out and Yes it says he will be discontinued next Feb which I find is the strangest thing about it

Anyone else seen anything like this?

 

[Chazm]

Crazy, I’ve never seen it but I would have him call SS to verify that he didn’t move. And the Ins company

 

[vic120]

Crazy, I’ve never seen it but I would have him call SS to verify that he didn’t move. And the Ins company

Going to call the ins company,But not too concerned will redo PDP in OCT anyway as I talked with him and they are not canceling till Feb of NEXT year

Just it is so strange of an issue and just curious in case I run into it again

Also curious how they can deem him as moved just because of med bills or whatever everything is still down from PA address tax's home and such

 

[alphawave2k]

Can he ask his PDP plan what his new address is? They seem to know better than him apparently. More seriously, they are aware of where he's obtaining his prescription meds, and are assuming he moved. I think PDP's require you sign up for a plan offered in your "service area", but not aware that you can't use it "outside" your service area, consistently or otherwise. That's an interesting situation...it would be good to know the final details of whether or not he can use his PDP consistently outside his state.

 

[TwoCents]

If they had proof that he moved, he would be immediately terminated and not in the future. So right now they have a suspicion that he's moved (question is what triggered it) and he should contact them to verify his address. I assume he's on a PDP that services Pennsylvania and would confirm with the plan that he's in PA.

 

[vic120]

Can he ask his PDP plan what his new address is? They seem to know better than him apparently. More seriously, they are aware of where he's obtaining his prescription meds, and are assuming he moved. I think PDP's require you sign up for a plan offered in your "service area", but not aware that you can't use it "outside" your service area, consistently or otherwise. That's an interesting situation...it would be good to know the final details of whether or not he can use his PDP consistently outside his state.

What it is he goes to NY for medical treatment but he does not live there, He has serious illness

 

[vic120]

If they had proof that he moved, he would be immediately terminated and not in the future. So right now they have a suspicion that he's moved (question is what triggered it) and he should contact them to verify his address. I assume he's on a PDP that services Pennsylvania and would confirm with the plan that he's in PA.

The same plan is offered in both states. So not the biggest deal Price dif is not much He hits doughnut hole does really make much a dif which plan he is on comes out to near the same anyway

 

[TwoCents]

The same plan is offered in both states. So not the biggest deal Price dif is not much He hits doughnut hole does really make much a dif which plan he is on comes out to near the same anyway

This is where you're technically wrong. PDPs cover regions. Most states are their own region. NY and PA are separate regions so they wouldn't be the same plan. For example Humana's NY Preferred PDP is S5552-004 in NY while in PA it's S5884-104. PA and West VA are in the same region so they'd both be S5884-104. I hope you're not telling your client to just ignore it; that advice never goes over well.

 

[vic120]

This is where you're technically wrong. PDPs cover regions. Most states are their own region. NY and PA are separate regions so they wouldn't be the same plan. For example Humana's NY Preferred PDP is S5552-004 in NY while in PA it's S5884-104. PA and West VA are in the same region so they'd both be S5884-104. I hope you're not telling your client to just ignore it; that advise never goes over well.

I get that but its same formulary and preferred pharmacy

Not telling him to ignore it but probably best way is to change drug plans in OCT

The cancel date is Feb of next year

 

[DS4]

I
He received a letter from PDP ( he has been on the same PDP for 3 years) The Letter states that they will discontinue his Drug cov next year as of 02/20 due to the fact that their records show he moved outside the service area

The PDP plan gleans their info from Social Security/Medicare. Where are his Medicare EOB's going?