UHC AEP Chargeback ?

[Rossat]

Wrote a 10/1 PDP client with UHC. During AEP switched to MAPD. UHC charged back the full amount. When inquired they advised the policy did not remain active for 3+ months and therefore is considered a rapid disenrollment and the chargeback is accurate.

I was under the impression an AEP enrollment does not classify as a Rapid Disenrollment per CMS MCMG (2019). UHC states this has been their rules "for years".

Does this sound right? If so, what's the advantage of placing any 10/1-12/1 with UHC?!

 

[DonP]

Wrote a 10/1 PDP client with UHC. During AEP switched to MAPD. UHC charged back the full amount. When inquired they advised the policy did not remain active for 3+ months and therefore is considered a rapid disenrollment and the chargeback is accurate.

I was under the impression an AEP enrollment does not classify as a Rapid Disenrollment per CMS MCMG (2019). UHC states this has been their rules "for years".

Does this sound right? If so, what's the advantage of placing any 10/1-12/1 with UHC?!

Uhc charges back all commissions in first 3 months no matter if you go Uhc to Uhc .Humana charges back unearned commission even in the first 3 months . Example 1/1 effective date terms 3/15 . United and most carriers charge back 100% . Humama only charges back 10 months or the unearned amount

 

[newbie2001]

Uhc charges back all commissions in first 3 months no matter if you go Uhc to Uhc .Humana charges back unearned commission even in the first 3 months . Example 1/1 effective date terms 3/15 . United and most carriers charge back 100% . Humama only charges back 10 months or the unearned amount

So if I write a T65 say for a 10/1 date on Humana or UHC. But then they move to a new carrier or new plan on the same carrier for 1/1 it’s a chargeback? Man that’s crazy talk.

What about T65 on UHC or Humana 10/1 effective but they retain the plan for 1/1 no chargeback right?

 

[vic120]

Ive been through this, I fought it and won, with UHC, However I did have to provide a screen shot of CMS rule, and did have much back and forth

denial and then upscaling the inquiry

I real Pain but they did pay after all of it because it is in fact a CMS rule that an AEP change is NOT rapid disenrollment

The question is, is it worth the time

 

[Rossat]

So if I write a T65 say for a 10/1 date on Humana or UHC. But then they move to a new carrier or new plan on the same carrier for 1/1 it’s a chargeback? Man that’s crazy talk.

This is what I don't get. If you write a member on a plan that's ending in August for 10/1 (unbeknown it's ending in August), then are forced to switch them for AEP, and you are chargedback... Doesn't sound fair.

If this is the case, then I just won't write UHc policies for 10/1-12/1. Not worth the risk.

 

[Rossat]

Ive been through this, I fought it and won, with UHC, However I did have to provide a screen shot of CMS rule, and did have much back and forth

denial and then upscaling the inquiry

I real Pain but they did pay after all of it because it is in fact a CMS rule that an AEP change is NOT rapid disenrollment

The question is, is it worth the time

IMO it's not about the time but the principal. If they want to apply CMS rules for everything else they do, they should be applying it to the commission piece as well.

 

[DonP]

So if I write a T65 say for a 10/1 date on Humana or UHC. But then they move to a new carrier or new plan on the same carrier for 1/1 it’s a chargeback? Man that’s crazy talk.

What about T65 on UHC or Humana 10/1 effective but they retain the plan for 1/1 no chargeback right?

I miss understood your note . No that’s not a chargeback . It’s a new yrJan 1st . I got 2 uhc I wrote new to Medicare for 12/1 . I’ve already wrote new 1/1 plans with them . I’ve seen no chargebacks and in the past I never got one

 

[StevenjKSU]

I had the exact same situation with UHC. I argued with their regional people for a day or two about it. They said the chargeback was right. First of January I got paid the full first time commission back again and that was that. They were enrolled 90 days, so it wasn't a QQ. It all worked out in the end, but was pretty frustrating in the moment.

 

[Special Agent]

I had the exact same situation with UHC. I argued with their regional people for a day or two about it. They said the chargeback was right. First of January I got paid the full first time commission back again and that was that. They were enrolled 90 days, so it wasn't a QQ. It all worked out in the end, but was pretty frustrating in the moment.

Ok so the CMS rule is that the carrier can choose not to charge you back for aep rapid disenrollment and i believe most companies didn't but UHC did until last AEP when UHC changed it's policy and no longer charges back.i know this first hand about MA so i assume it would include PDP

another thing that may or maynot be new with UHC commissions is let say you write a new to medicare ma for 10/1,11/1 or 12/1 effective and you switch them to a plan that UHC is offering for the first time 1/1 you do not lose the true up commission

for example UHC has the new Dual Complete SNP plans for full Medicaid dual that start 1/1 in florida (y-5,y-4)but you enroll a new to medicare in the uhc dual complete for 10/1 you won't be charged back the tru up even though they were on the original plan only 3 months.

 

[ValeRosso]

Money-grubbing insurance companies gonna money-grub