I have a HUGE problem, How do i fix this? no coverage!

[Cenla Agent]

My understanding is that the option for a guaranteed issue supp for those enrolling in MA for the first time only applies during the next AEP or OEP. If they made a change after 1/1/07 the OEP is blown and they are locked in. But I only sell MAPD's, not stand alone MA, so there may be a different rule for that. I have heard that the rules were changed for MA only plans so that the OEP for that does not end on 3/31/07, but I was under the impression that the rule of only one change after 1/1/07 still applies unless they are aging in or they move out of the service area but I could be wrong.

Also in general, the agent has to be careful with simply assuming that a member hasn't been enrolled in MA before. I've come across several clients who had been enrolled in one years ago (i.e. Sterling or a HMO) and either didn't realize it or forgot.

And BTW I am a he not a she

 

[senior-advisor-indiana]

No they can get the gaurantee med supp anytime in the first 12 months of a plan. That's what everyone one has told me. I have done that also.

 

[Cenla Agent]

No they can get the gaurantee med supp anytime in the first 12 months of a plan. That's what everyone one has told me. I have done that also.

It looks like this may be right, that it isn't limited to the AEP or OEP. Well that's what these forums are for.

In two years of marketing these plans I can't think of a situation where this option needed to be used. I don't think I've enrolled anyone this year who was replacing a supp, this largely being due to the high premiums for the MA plans in the areas I've been working. My enrollments this year have been either people who don't have a supplement or recently dropped one because it became too expensive.

 

[senior-advisor-indiana]

A little pressure does the trick

I recieved a wonderful phone call today from my client with HIV. He informed me that Pyramid had called him today to tell him they were going to reinstate his policy. WHAT A RELIEF! I assume that the department of insurance contacted them because we havent communicated with pyramid since we filed the complaint.

How rediculous is it that you have to file a complaint to have a company do the right thing. I did not talk to Pyramid personally so I hope that they are going to reinstate from 2-1-07, not just reinstate for this month.

I will find out in a couple days. Do you think they are going to cover him for feb, Mar and april?

 

[Frank Stastny]

With Med Supp policies the reinstatement will be retroactive as long as the client pays the back premium.

I would get on the phone and call Pyramid today, explain the situation, thank the person you talk to for all their help, and find out exactly what they are going to do. You always get a lot better service when you thank people even though they had nothing to do with it.

I'm surprised that they didn't give your client a reinstatement date when they called. Maybe they did and he just forgot to tell you.

Good job following through, that is an excellent example why people do need an insurance agent. Too many people today think they can do everything themselves. "I don't need no damn insurance agent." WRONG!

 

[senior-advisor-indiana]

I did call Pyramid personally in the begining and they said there is no possible way to reinstate, he would have to answer health questions to keep his plan. I said well this is not right and you ccan't take his coverage. What would happen if they divorced or she died. They saied sorry, nothing we can do, I said do you have the IN dept of insurance phone number, they said no, I said ok i'll fing it myself and we have them figure it out.

That was like 2 weeks ago. So i am guessing the IDOI had something to do with it. I am not thanking pyramid for crap! I try being nice the first couple times, it doesnt work with them.

 

[Frank Stastny]

In that situation I would'nt be nice either.

I always start out that way until I learn that being nice doesn't get you a damn thing except let them know that you are a "nice guy". We all know where they finish.

Why is it always necessary to "raise hell and put a chunck under it", call the DOI and get everyone pissed off to get something done?

Oh, and be "politically correct" in the process.

They should be very thankful they have an agent willing to "go to the wall" for them. I hope they appreciate your efforts.

 

[senior-advisor-indiana]

They do appreciate me. They feel like I am doing to much for them. They were not mad at me at all through the whole process. I felt like it was my fault so I had to help fix it. I always try to be a nice guy unless someone is completely out of line.