A Client’s Coverage is Cancelled for Moving:
This is a heads up caution to all Medicare members who are enrolled in a Part D Prescription plan and move out of your providers service area. We are trying to assist a client and his family in getting his coverage reinstated due to a poorly handled notification procedure by the provider. Here’s a snapshot of what happened.
The daughter complied with the request right away, and provided the new address on the form, then mailed it, not knowing that her father would be automatically disenrolled from his plan with no coverage in place effective the following month. Her father lost his coverage within two weeks from the time the letter was received by her.
The daughter has filed an appeal with the provider and I followed up yesterday with a two page FAX pointing out the misleading and poorly worded notice and suggested the company rewrite the letter and change the notification procedure.
I’m amazed that a major provider would have such a shabby procedure in place and not spell it out in the letter and tell the client or their legal representative that the client could lose their coverage.
So if you don’t comply with the request and don’t verify your new address, we won’t disenroll for another 12 months. But if you comply and tell us where you are, your plan will be cancelled.
How’s that for thinking you are doing the right thing by providing the information. The reward for not complying is an extended 12 month coverage with no other questions asked. The intent of this rule was designed to accommodate folks who temporarily move out of their service area and plan to return. The provider letter stated: “You can live up to twelve months outside of our service area and remain a member of your prescription plan with us.” Then the next paragraph buried the dagger by saying “if you permanently move, we must disenroll you, (‘this should have been the lead line in the message and at the top of the page in bold letters’), and then the provider provided part two in a compounded sentence, “ and if you live outside the service area more than 12 months in a row, we must disenroll you from the plan.”
The Centers for Medicare and Medicaid Services require that aprovider must disenroll the insured upon the provider’s notification that he or she has moved from the service area but the word notification was missing when the daughter read the letter. But, the provider didn’t state that point clearly to let the daughter know that if she replied as requested by the provider there would be consequences for her father and he would lose his coverage. We believe the charges for the month of June should be covered, and are waiting for the decision by the Provider’s Grievance and Appeal Committee.
Note this detail if you ever get into this situation. If an insured member moves out of a provider’s area, contact the provider before the move and ask the following questions:
1. Now that I have informed you of the move, what is the next step?
2. Will I be disenrolled automatically because I have told you of the move? The answer is yes? Go figure that one.
3. What are my options to enroll in another plan that is approved by the state I am moving to?
4. When will this plan be effective?
5. What do I need to do to enroll in this new plan so there is no lapse in coverage?
The daughter enrolled her father in another plan that will beeffective July 1st. But, because her father was automatically disenrolled from his existing plan, he now has no coverage during the month of June and the company says he must pay for the prescription costs for that month. We believe that this is unfair and we will continue to appeal even if we have to go directly to the Medicare and Medicaid Services officials in Baltimore, MD.
Coach
