Tricked by Carrier That Enrolled Client in HMO

[somarco]

Deceptive practice. I received a Client email an hour ago stating "My wife got a call from a #Wellcare salesman in October trying to sell her on Medicare Advantage. She said NO, but somehow Wellcare decided it was better for her Part D (drug coverage) to be changed to their Medicare Advantage plan. So they changed it WITHOUT her knowledge or approval."

WC sent her a letter dated 12/8/2023 "confirming" her disenrollment from the WC Value Script and enrolling her in a WC HMO. Same letter stated that her WC VS plan would not cover her drugs beginning 1/1/2024. This statement does not account for a new prescription her doc wanted to see if it worked before possibly writing a prescription for a different medication.

The MBO has been advised of the situation. Waiting on a response.

If they can't/won't reinstate the old plan (which she no longer wants because of this incident) and backdate coverage to 1/1/2024, we will use the OE to put her in a different PDP. I also told her to pay the January Medigap premium and, if possible, postpone any provider appointments scheduled in January.

This really steams me.

 

[ValeRosso]

This scenario seems unlikely, unless it was a rogue employee or imposter Wellcare, or the husband had absolutely no idea what was actually said on the phone. The statements that are read from WellCare alone should have set off red flags to the wife to alert her to what she was doing.

If it was WellCare and she did decline everything, that should be an easy firing of that employee. Wouldn’t this situation (if correct) qualify for a special circumstance or enrollment error sep?

 

[somarco]

If it was WellCare and she did decline everything, that should be an easy firing of that employee. Wouldn’t this situation (if correct) qualify for a special circumstance or enrollment error sep?

These clients, husband and wife, have been clients for several years. Both are educated and bright. And both are completely on board with the OM + Medigap package. (FWIW, wife retired from KP and wanted nothing to do with a managed care plan, especially an HMO).

Could be a rogue/rookie employee gunslinger trying to bag as many new sales as possible.

Even if that is the case, is there no oversight by managers for this kind of crap? Calls are recorded but so what? If no one monitors the recordings all is for naught.

I can "correct" this problem by enrolling her in a PDP during January since she now has an HMO plan. However that does not address any potential claims that may occur in January.

Plus she has at least one, maybe two specialists that are trying to control her condition by fine tuning the meds.

Then some WC yokel waltzes in with a bazooka and blows everything up.

Doesn't say much about WC training or oversight, does it?

Fortunately her condition is not life threatening . . . continuation of coverage does not involve impending surgery or ongoing infusion therapy.

The WC rep should be fired and WC fined severely over this money grabbing stupidity.

I should not have to ride in on a white horse, guns blazing, to take care of a problem I did not create.

 

[hockeyday]

These clients, husband and wife, have been clients for several years. Both are educated and bright. And both are completely on board with the OM + Medigap package. (FWIW, wife retired from KP and wanted nothing to do with a managed care plan, especially an HMO).

Could be a rogue/rookie employee gunslinger trying to bag as many new sales as possible.

Even if that is the case, is there no oversight by managers for this kind of crap? Calls are recorded but so what? If no one monitors the recordings all is for naught.

I can "correct" this problem by enrolling her in a PDP during January since she now has an HMO plan. However that does not address any potential claims that may occur in January.

Plus she has at least one, maybe two specialists that are trying to control her condition by fine tuning the meds.

Then some WC yokel waltzes in with a bazooka and blows everything up.

Doesn't say much about WC training or oversight, does it?

Fortunately her condition is not life threatening . . . continuation of coverage does not involve impending surgery or ongoing infusion therapy.

The WC rep should be fired and WC fined severely over this money grabbing stupidity.

I should not have to ride in on a white horse, guns blazing, to take care of a problem I did not create.

At what point did you notice she was missing from your book of biz, what did your Wellcare rep say?

 

[sshafran]

Deceptive practice. I received a Client email an hour ago stating "My wife got a call from a #Wellcare salesman in October trying to sell her on Medicare Advantage. She said NO, but somehow Wellcare decided it was better for her Part D (drug coverage) to be changed to their Medicare Advantage plan. So they changed it WITHOUT her knowledge or approval."

WC sent her a letter dated 12/8/2023 "confirming" her disenrollment from the WC Value Script and enrolling her in a WC HMO. Same letter stated that her WC VS plan would not cover her drugs beginning 1/1/2024. This statement does not account for a new prescription her doc wanted to see if it worked before possibly writing a prescription for a different medication.

The MBO has been advised of the situation. Waiting on a response.

If they can't/won't reinstate the old plan (which she no longer wants because of this incident) and backdate coverage to 1/1/2024, we will use the OE to put her in a different PDP. I also told her to pay the January Medigap premium and, if possible, postpone any provider appointments scheduled in January.

This really steams me.

It happens and it's unfortunate but (my opinion) it seems like the carriers don't really care.

I had a similar email this week. Client got confirmation of a Humana PPO she did not sign up for (according to her at least).

 

[somarco]

It happens and it's unfortunate but (my opinion) it seems like the carriers don't really care.

Of course they don't . . . especially if there are no repercussions. Carriers, and the agents they use, only care about the Benjamin's, no matter how disruptive this is to the beneficiary they enrolled. It's just another bounty collected.

The agent or the carrier that colluded in this transaction did not give this lady better coverage, and in fact made her situation worse.

I am not upset over possibly losing the $26 commission . . . but I am pissed at what this agent did to my client.

 

[sshafran]

Of course they don't . . . especially if there are no repercussions. Carriers, and the agents they use, only care about the Benjamin's, no matter how disruptive this is to the beneficiary they enrolled. It's just another bounty collected.

The agent or the carrier that colluded in this transaction did not give this lady better coverage, and in fact made her situation worse.

I am not upset over possibly losing the $26 commission . . . but I am pissed at what this agent did to my client.

Absolutely. You'd think there would be steep consequences.

There should be.

 

[DonP]

Somarco your clients lieing . If they got flipped in Oct as you said they would have gotten Pdp term letter no latter than Nov 10-14th and zero chance on Dec 8th . Clients lie I’ve found out .

 

[Russ]

If she switched in October it would have showed on your book of business with Wellcare as terming Dec. 31st, by early November.

 

[somarco]

I have the letter from WC to my client dated 12/8/2023 stating their current WC PDP would be terminated and the HMO would be effective 1/1/2024.

When they called WC they were told they could change back during the MA OE in January.

I did not get a termination notice from WC

I deal in facts, not lies.

Clients don't always open mail, especially during AEP.

YOUR clients probably lie . . . mine don't.