UHC Denies SEP Because Client Cancelled Their Plan when They Moved from IL to FL. Advice Please

[MBAgent]

So we have a client that moved from IL to FL. They had an individual BCBS IL policy, so logically they cancelled it once they got to Florida (and prior to contacting us).

The BCBS IL policy is set to expire 7/31.

2 weeks ago, we submitted a UHC off exchange application in FL with backup documentation showing previous and current address as well as the BCBS IL cancellation showing the 7/31/2016 cancellation date.

UHC is telling us that the client does not qualify for a SEP because they cancelled their insurance on their own.

I called last week and requested it to be reopened and explained the situation. The person on the phone understood the situation and sent it over to be re-opened. Since then I've been calling every other day to check on the status of the 'reopening' and they've just said "no update yet". Today they said it won't be reopened because the client does not qualify for a SEP. I was able to leave a voicemail with a supervisor who will hopefully call me back today.

The rep said the client should have contacted the carrier and requested an address update. Then the carrier would have told them that their plan isn't available in FL and would have sent a cancellation letter stating that.

Anyone else run into a situation like this? Any suggestions? Advice?

What do you do when common sense is thrown out the window???

Thanks in advance

 

[Tkruger]

You may want to consider Humana, Aetna or cutting it loose and telling them to call BCBS of FL. Cutting them loose would be the best for the client as BCBS of FL surely would have communication channels with BCBS of IL and allow them to prove the SEP.

 

[MBAgent]

You may want to consider Humana, Aetna or cutting it loose and telling them to call BCBS of FL. Cutting them loose would be the best for the client as BCBS of FL surely would have communication channels with BCBS of IL and allow them to prove the SEP.

Thanks for the advice. UHC called back and their compliance department squashed the deal. At this point, sending them over to BCBS FL probably makes the most sense.

 

[TN_agent]

It is possible they will have a month's lapse. I know for two of my carriers in TN, if the SEP is for moving, they will use the "must sign up by the 15th of the month" rule rather than the first of the next month due to loss of coverage rule for start dates because it is voluntary.

 

[Krball]

I'm late to following this one but would love to know the outcome. Also, if the FL enrollment is run through the federal exchange, then don't the exchange rules apply and the carrier really doesn't have a say?