Does IEP Election Code Trump Proposed Effective Date?

[yogooglethis]

I screwed up and sent an electronic PDP app for a 1/1/1 effective date that was supposed to be for 12/1/14 effective however I did put the correct IEP code .UHC PHD said it can't be changed but in the past I had submitted another IEP application requesting an effective the month after the person turned 65 and instead of giving the consumer the requested effective date the enrollment dept defaulted the effective date to the 65th birthday month instead of the following month as requested. When I called about this I was told any IEP coded app sent in b4 t65 month defaults to t65 month. So which is it?

The big problem in this case is that the guy has 2 drugs to fill this month that cost about 1,000.00

 

[WCMason]

I screwed up and sent an electronic PDP app for a 1/1/1 effective date that was supposed to be for 12/1/14 effective however I did put the correct IEP code .UHC PHD said it can't be changed but in the past I had submitted another IEP application requesting an effective the month after the person turned 65 and instead of giving the consumer the requested effective date the enrollment dept defaulted the effective date to the 65th birthday month instead of the following month as requested. When I called about this I was told any IEP coded app sent in b4 t65 month defaults to t65 month. So which is it? The big problem in this case is that the guy has 2 drugs to fill this month that cost about 1,000.00

The rule is that the IEP beneficiary gets the first effective date they're eligible for, not the effective date applied for.

So, if this was submitted in November, he should have gotten a December 1 start regardless of what you put on the application. That's my understanding of what is supposed to happen, anyway.

 

[yogooglethis]

The rule is that the IEP beneficiary gets the first effective date they're eligible for, not the effective date applied for.

So, if this was submitted in November, he should have gotten a December 1 start regardless of what you put on the application. That's my understanding of what is supposed to happen, anyway.

Thanks that's what I thought I will call the UHC PHD back to challenge this and I keep hanging up until I get a non Philippino rep. to help me.

 

[medicareguru]

Since when can you do a UHC PDP application online?

 

[G.Gordon]

I'm not looking at it as a code over rules the requested effective date put on the application.

Someone can very well be in their IEP, for this guy, December, January, February and March and request an effective date later than the first of the next month.

Your best bet in not having to write a $1k check to fix your screw up is get him on the phone with 800.medicare and explain the situation and see if you get a rep that is sympathetic with your reasoning. If so, file a complaint against the plan via medicare for them to reset the date.

 

[WCMason]

I'm not looking at it as a code over rules the requested effective date put on the application. Someone can very well be in their IEP, for this guy, December, January, February and March and request an effective date later than the first of the next month. Your best bet in not having to write a $1k check to fix your screw up is get him on the phone with 800.medicare and explain the situation and see if you get a rep that is sympathetic with your reasoning. If so, file a complaint against the plan via medicare for them to reset the date.

Page 98 of the Medicare & You publication is pretty clear about when one can get an effective date during their Initial Enrollment Period. First day of the next month after enrollment or first day of eligibility.

Paying $1K to fix this could create a much bigger problem than it would solve.

 

[TwoCents]

I screwed up and sent an electronic PDP app for a 1/1/1 effective date that was supposed to be for 12/1/14 effective however I did put the correct IEP code .UHC PHD said it can't be changed but in the past I had submitted another IEP application requesting an effective the month after the person turned 65 and instead of giving the consumer the requested effective date the enrollment dept defaulted the effective date to the 65th birthday month instead of the following month as requested. When I called about this I was told any IEP coded app sent in b4 t65 month defaults to t65 month. So which is it?

The big problem in this case is that the guy has 2 drugs to fill this month that cost about 1,000.00

(1) I would want to know the entitlement dates to verify that the person is within the IEP since you're error prone. (2) Some carriers are set up so if you wanted that 12/1 start date you'd have to choose from a list of 2014 plans. It sounds like you were looking at 2015 plans so the application was likely processed with the AEP election for the 1/1/15 start date. (3) A person can't choose an effective date using IEP. If it's done in the first 3 months, then it's the first of the month T65, if it's done any later then the plan will start the first of the following month.

If you talked to the absolute right person at the plan, then maybe they'd fix the start date.

 

[bpenn9]

Since when can you do a UHC PDP application online?

MyMedicareenroll.com or electronically if you have a sig pad.

 

[medicareguru]

Would it be an accurate statement in saying that if you do too many enrollments through that website that it will raise red flags?

 

[bpenn9]

Would it be an accurate statement in saying that if you do too many enrollments through that website that it will raise red flags?

Well, the client needs to do it from their computer. I did see an email that a couple agents were abusing it. I don't remember exactly the case.