Unauthorized Enrollment

[wolf5150]

Need some feedback and advice, TIA. A friend of mine told me that her Mom (Dual/LIS) was recently enrolled into a Wellcare MAPD plan effective 9/1. The problem is that Mom never spoke to any agent/broker/sales regarding this enrollment. Someone took it upon themself to inappropriately enroll a member with no authorization. Per standard procedure, Mom's Wellcare Part D plan was replaced, I don't have the details of the plan she had for medical.

I'm very aware of the unscrupulous nature of some folks in our business, even in these current times where strict measures have been implemented to avert these situations.

Having said all that, does anyone have similar experience to this situation and how was it handled? What options (if any) does a member have to terminate unauthorized plan and return to prior plans?

 

[DonP]

In my vast exp dealing with duals she 100% talked to someone . Whether she remembers it is another story . Todays 15 th of month . I assure you if you call Medicare it’ll take 4-6 weeks to reverse it . There’s many seps to use ti move her back to old plan on 10/1

 

[Special Agent]

do three way call to medicare to file complaint if she has to have a retroactive disenrollment .You can ask medicare or wellcare the method of enrollment and date before filing a complaint to see if it is possible she actually authorized enrollment but doesn't remember.

 

[DonP]

do three way call to medicare to file complaint if she has to have a retroactive disenrollment .You can ask medicare or wellcare the method of enrollment and date before filing a complaint to see if it is possible she actually authorized enrollment but doesn't remember.

It’s fine if you want to file a complaint fine but based on my experience it will be 4-6 weeks before retroactively enrolled . I’d rewrite for 10-1 if you have sep . I’d bet 99% if done by call center she has voice sig in there .

 

[wolf5150]

I told my friend to request a copy of the scope of appointment and application to shed more light on this matter.

 

[hockeyday]

It’s fine if you want to file a complaint fine but based on my experience it will be 4-6 weeks before retroactively enrolled . I’d rewrite for 10-1 if you have sep . I’d bet 99% if done by call center she has voice sig in there .

Call Center, lol I'm saying Wellcare called her and flipped her

 

[hockeyday]

Need some feedback and advice, TIA. A friend of mine told me that her Mom (Dual/LIS) was recently enrolled into a Wellcare MAPD plan effective 9/1. The problem is that Mom never spoke to any agent/broker/sales regarding this enrollment. Someone took it upon themself to inappropriately enroll a member with no authorization. Per standard procedure, Mom's Wellcare Part D plan was replaced, I don't have the details of the plan she had for medical.

I'm very aware of the unscrupulous nature of some folks in our business, even in these current times where strict measures have been implemented to avert these situations.

Having said all that, does anyone have similar experience to this situation and how was it handled? What options (if any) does a member have to terminate unauthorized plan and return to prior plans?

I would start with Wellcare care and ask them if they flipped her,

 

[hockeyday]

Need some feedback and advice, TIA. A friend of mine told me that her Mom (Dual/LIS) was recently enrolled into a Wellcare MAPD plan effective 9/1. The problem is that Mom never spoke to any agent/broker/sales regarding this enrollment. Someone took it upon themself to inappropriately enroll a member with no authorization. Per standard procedure, Mom's Wellcare Part D plan was replaced, I don't have the details of the plan she had for medical.

I'm very aware of the unscrupulous nature of some folks in our business, even in these current times where strict measures have been implemented to avert these situations.

Having said all that, does anyone have similar experience to this situation and how was it handled? What options (if any) does a member have to terminate unauthorized plan and return to prior plans?

Wellcare markets very hard to their pdp enrollments, I never give them a phone number or email

 

[somarco]

Same thing happened to one of my clients last year. The agent submitted the application on 12/7 . . . WC sent a "thank you letter to her on 12/10. Her new HMO would be effective 1/1/2024.

She was in the middle of treatment and her doc was not in network for the HMO.

We got the ombudsman involved. Too late to reinstate her PDP. Thankfully her Medigap was untouched. PDP reinstated effective 2/1/2024.

 

[MedicareWAA]

In my vast exp dealing with duals she 100% talked to someone . Whether she remembers it is another story . Todays 15 th of month . I assure you if you call Medicare it’ll take 4-6 weeks to reverse it . There’s many seps to use ti move her back to old plan on 10/1

It’s very easy to fix this. It won’t take 4-6 weeks unless you’re talking about a retroactive fix.

Member (or POA) calls Medicare and is granted SEP based on the allegation that’s been described. Medicare grants the SEP and client is back in their old plan no longer than 1st of upcoming month.

CTM goes to WellCare, they investigate it, and CMS does its thing. Which is to say they’ll hold no one accountable … but the client will be back in the plan they want.