Getting a Refund from Humana While on a MAPD

[pbbaseball]

Had a weird situation today. Sold a customer a new plan in December for a Medicare advantage plan that would start effective January 1. Once I saw that their policy was enforced and I quit watching football, I faxed a cancellation letter into Humana on January 3 to cancel the Medicare supplement.


Of course today the customer called me and said that Humana drafted their account. When we called humana to get the refund they said they never received the fax. I keep a copy of all of my faxes and confirmations because one out of five times i send a cancellation in, the insurance company claims they never receive the fax.

After sending in the confirmation along with the original cancellation and proof of coverages from Blue Cross that her policy was approved, and explaining to the person that the customer did not need a supplement on top of the advantage plan because then the supplement wouldn't pay, Humana said that they would not cancel policies after the first of the month if a cancellation request was not received by the 31st. If the customer paid they were responsible for the entire month, and could not get out mid month.

Anyone ever ran into this before? I replace med supps all the time, but have never had this happen in 13 yrs, at least not that I've known of!

 

[DS4]

You client does not have Part A & B of Medicare as of 1.01.12.
Therefore, not eligble for a med supp.
End of story.
Yes, I have had the same problems getting someone cx'd.
Usually you have to talk to someone in CS with an IQ greater than 20 and you can get this issue solved.

 

[Dave020]

Usually you have to talk to someone in CS with an IQ greater than 20 and you can get this issue solved.

Where do you find such a mythical beast?

 

[SportsNut]

You client does not have Part A & B of Medicare as of 1.01.12.
Therefore, not eligble for a med supp.
End of story.
Yes, I have had the same problems getting someone cx'd.
Usually you have to talk to someone in CS with an IQ greater than 20 and you can get this issue solved.

Well due to not having M'care A&B they are not eligible for claims to be paid the med supp policy. Humana would still rather that they continue paying the premium, however.

Anthem has the same story line; cancellations the 1st of the month following receipt of cancellation notice.

To the OP, if you can prove the Humana that you have a receipt of the fax being sent and rec'd, you should have a pretty good chance of getting them to cancel the policy back to 1.1.12.

What I do whenever I send a cancellation notice to any company, bearing the insured's signature, I also cc: DOI, consumer affairs dept. Seems like everyone of these requests are processed immediately. Might suggest that you write Humana a letter, or do so for the clients signature and send a copy of the letter along with a copy of the fax receipt, CC: DOI consumer affairs dept... or OSHIP for your respective state.

 

[DS4]

If you read any Medicare supplement EOC, there is a section entitled "When Your Coverage Ends".

"when you no longer have coverage under both Part A & B of medicare, or, you enroll in a MA"

Like I said early, find someone in CS that thinks resonably, explain the situation, and, provide proof of enrollment in the MA.

 

[pbbaseball]

you guys pretty much echoed my sentiments... their customer support is the worst here lately. i'll grin a little bigger every time I replace one of their policies!

 

[Midlevel]

Ran in to this where we forgot to send in cancellation letter. Got a call that client got drafted in January even though he has MAPD effective 1/1/2012. Called Med Sup company and they said you can send in a cancellation letter but it will not cancel effective 1/1/2012 but rather the day they receive the request. They say the client is just out the 26 days of premium. This client has had a quite a few claims already in January on his MAPD, is there a way to run the claims back through his A and B plus Medicare Supplement F Plan? His copays he would avoid would easily cover his premium that he is out.

 

[Todd King]

Ran in to this where we forgot to send in cancellation letter. Got a call that client got drafted in January even though he has MAPD effective 1/1/2012. Called Med Sup company and they said you can send in a cancellation letter but it will not cancel effective 1/1/2012 but rather the day they receive the request. They say the client is just out the 26 days of premium. This client has had a quite a few claims already in January on his MAPD, is there a way to run the claims back through his A and B plus Medicare Supplement F Plan? His copays he would avoid would easily cover his premium that he is out.

Since the client was effectively dis-enrolled from Medicare A&B and enrolled in Part C, they claim can't be paid by A&B and thus the supplement can't pay.

I will go further to say that the supplement company CAN NOT keep the client's money or charge them for a policy that can't be in force.

Tell the company to refund his money or you will be reporting them to CMS and the DOI. Speak with a supervisor there. I'm sure you'll get the desired results of getting the client his money back.

 

[Midlevel]

Just talked to the company and they say they answer questions all day long about it and the management changed it about 5 months ago. They will not refund the money and told me to send claims in to them. I said what do I send, they said Medicare Explanation of Benefits, I said there are none because the MAPD is paying the claims. She couldn't answer my question and quickly transferred me to someone's voicemail.
I called the Dept. of Insurance and they said you can have both MAPD and a Medicare Supplement legally in case you have OON costs or other copays you want he Supplement to cover. Can't imagine anyone ever purposely having both but it is legal. She told me to just send in the Drs. bills or the Explanation of Benefits from the MAPD to the Med Sup Company.

 

[Todd King]

Someone at your DOI doesn't know what they are talking about. How can it be justtified that a person on a MA plan can still have a supplement that will never pay?

The Medicare Supplement "supplements" Part A and B. If the client is not covered by Parts A and B, then what is there to "supplement"?

Also, the company many have changed their policy on refunds, but the still have to abide by rules. Go ahead and send them a Dr's bill or an EOB and they'll deny it all day long because the client is not covered by Parts A&B of Medicare!