Possible Complaint - Medicare Advantage

[InsuranceManFL]

I had a client during open enrollment who I met with twice, well documented, that went from a HMO plan that received a portion of the Part B premium back to a Humana PPO plan which of course does not. His Dr. Was no longer on his old plan is the reason for the switch. Now he is unhappy and wants to go back to his old plan and states I did not explain that the new plan did not receive part of the Part B premium back after going over the summary of benefits twice. What can I do?? The new plan has a 1/1/16 effective date and I cannot afford a complaint, never had one before.

 

[Experienced Agent]

It sounds as if you have the opportunity to head this off before it gets to complaint. If your able to do so, you want to get back in the house. Most seniors will not file a complaint if you get more face time. This is an opportunity to smooth things over. Your out of AEP so he's stuck with the plan unless he has an SEP. methodically go through SEP options, if he has none, he's not moving unless he wants to change to med supp and drug card.

Dig deeper into the plan, show this person that there is more value with Humana. If the the old plan was a strict HMO, I'd beat the referral issue hard. I'd also look at Humana pharmacy and see if there are savings with drugs or OTC benefits. Find the value and reestablish this, it may help.

Also, let this person know your a quality agent and your not hiding from the problem, seniors tend to appreciate that. Seldom are complaints filed when you do this. Lastly, if this person files a complaint, just document properly. You could come out on top, not likely, but possible. If not, you have one complaint, it's not the end of the world, everybody that does high volume gets one sooner or later.

 

[yogooglethis]

I had a client during open enrollment who I met with twice, well documented, that went from a HMO plan that received a portion of the Part B premium back to a Humana PPO plan which of course does not. His Dr. Was no longer on his old plan is the reason for the switch. Now he is unhappy and wants to go back to his old plan and states I did not explain that the new plan did not receive part of the Part B premium back after going over the summary of benefits twice. What can I do?? The new plan has a 1/1/16 effective date and I cannot afford a complaint, never had one before.

The bad news with that type of complaint is that CMS expects agents to make sure that consumers understand they must keep paying their part B premium .I know from personal expierence that sometimes consumers confuse 0 plan premium to mean 0 deduction for part B

The good news is that he should still be able to cancel the new plan before 1/1/16 and stay on premium rebate plan.

 

[Experienced Agent]

The bad news with that type of complaint is that CMS expects agents to make sure that consumers understand they must keep paying their part B premium .I know from personal expierence that sometimes consumers confuse 0 plan premium to mean 0 deduction for part B The good news is that he should still be able to cancel the new plan before 1/1/16 and stay on premium rebate plan.

Without an SEP, the client can't change back to old plan. AEP is over and all changes are final.

 

[Chazm]

Bingo, I can't tell you how many times people say, oh I was on a plan that refunded my part B premium and this UHC plan has a zero premium as well. No ma'am, it doesn't work that way.

Like posted, just call to have the app canceled but make sure they can get back on the old plan. Might have to call Medicare.

 

[yogooglethis]

Without an SEP, the client can't change back to old plan. AEP is over and all changes are final.

cant change plans after 12/7 but they can cancel new enroolment for for 1/1/16 and CMS will automatically retain the his 2015 plan.Thats what they do

Just a heads up - as a safeguard be on the 3 way call when he cancels because people like to give a reason why they are cancelling so they don't feel like a time waster or indecisive and in doing so can inadvertantly throw you under the bus

 

[InsuranceManFL]

cant change plans after 12/7 but they can cancel new enroolment for for 1/1/16 and CMS will automatically retain the his 2015 plan.Thats what they do Just a heads up - as a safeguard be on the 3 way call when he cancels because people like to give a reason why they are cancelling so they don't feel like a time waster or indecisive and in doing so can inadvertantly throw you under the bus

Thanks, the customer is calm again and like everyone said can go back to his old plan. The customer apologized actually and all I have to do now is do the conference call. Appreciate all the feedback, had me nervous for awhile there.

 

[WCMason]

Without an SEP, the client can't change back to old plan. AEP is over and all changes are final.

This is not true if the beneficiary wants to keep the 2015 plan. Cancelling the enrollment reinstates the 2015 plan which will roll into 2016 as if the new enrollment never happened.

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Thanks, the customer is calm again and like everyone said can go back to his old plan. The customer apologized actually and all I have to do now is do the conference call. Appreciate all the feedback, had me nervous for awhile there.

Almost everyone said that. Didn't read through to the last post to see you got your answer. All is well.

 

[wehotex]

Without an SEP, the client can't change back to old plan. AEP is over and all changes are final.

No. Not true. New plan has not started yet. They can still revert to the "old plan" prior to Jan 1.

 

[tesflex]

Reason 392 of why I have stopped selling MA plans. Too much trouble.