If you apply late, last minute for coverage, when does it start?
What if you apply on March 30th for an April 1st effective date and you don’t get ID cards till April 24th,
do you have to pay April premium?
What about trying to collect on claims paid out of pocket?
Introduction
Here’s a story about a bad situation, where a client waited till the last minute to get coverage. They were very uncooperative in giving any information the Insurance Company required. When they finally gave the check that was required with the application, they misunderstood what we told them on the phone. Nor did they read the Insurance Company rules in the email we sent to memorialize the conversation. Then they tried to extort the first months premium payment from us.
Kaiser for example now has a form that must be signed when
applications are sent in late to avoid any misunderstanding.
In order for your group, ___________to be considered for late enrollment for a/an _________effective date, both customer and broker will need to sign this letter of understanding.
Complete group eligibility and enrollment documentation must be submitted. This letter and/or group submission do not guarantee approval, but rather consideration for a/an _____effective date.
Please note the following potential liabilities of a late enrollment:
Customer is responsible for the full month’s premium – no proration or refunds
Effective date of coverage will not be changed to a future date
Potential impacts to members:
Members will not have member ID cards, nor be active in systems, including medical facilities, until enrollment is complete and processed, which could take 7- 10 business days beyond submission
Members may be billed or asked to pay at point of service. Kaiser Form *
We do not need the grief and threats of these types of emails from anyone!
Excerpt of extortion email:
When I talk to these folks, [Blue Cross] I will tell them that falsified information, advising me that I was paying for the month in advance.
***I did NOT advise that. See email that I sent you to clarify the conversation!
If they don’t agree, to move the insurance to the month of May, as our start date, I’ll be terminating the service.
If you would like to reimburse us for the 3 weeks of this month that we were unable to use the service, I will not bother with any of the above. I’ll also be cancelling my medical supplement with you, during my open period, next month.
Let me know what you’d like to do. I’d like to chalk this up to miscommunication. Next time, when a customer asks if she is paying for a service in advance, you might want to say “no, as a matter of fact, your paying for a month that’s almost over.”
IMHO the threat to say negative (criminal things) and demand $$$ is Extortion & Black Mail Penal Code §518 ShouseLaw.com
Excerpt of our email to follow up the conversation
Hi xxx,
Please see attached Blue Cross Checklist. It does not matter if you believe you’ve bought insurance for 35 years without a deposit check, as mandated in # 8. That’s the requirement now. Please ask more relevant questions and not argumentative ones. Please use email so I can look up the answers and citations.
Hearsay – what someone else is alleged to have said
We also don’t want to hear about alleged phone conversations with Covered CA or Insurance Company CSR’s. Get it in writing. Here’s someone who spent a year and a half trying to get their address changed, we did it in 6 minutes!
If you got a letter from Covered CA or an Insurance Company, email it to us. If we are your Covered CA agent, it should be in the agent portal though. We can check.
Here’s where we are trying to help someone who said Kaiser didn’t tell them they must use Kaiser for all medical services.
Our Medicare Advantage Mandatory Training talks of documenting every sales call.
The training is secret… I’m looking for public information
Best Practices for handling Personally Identifiable Information
Key Resources for Agent and Broker FFM Requirements and
Regulations
• Overview of FFM Standards of Conduct for Agents and Brokers
• Providing Accurate Information to the Marketplaces and Consumers
• Best Practices for Interacting with Consumers
• Requirements for Naming Your Business or Website
• Privacy Notice Statements
• Consumer Consent Record
• Authorized Functions of PII and Reporting PII Breaches
• Monitoring and Oversight
Medicare.Gov
During the meeting, Medicare plans and people who work with Medicare can’t:
- Communicate incorrect information about their plan type or use inappropriate statements like their plan is “the best” or “highest ranked.”
- Tell you about other plan options you haven’t agreed to discuss, unless you specifically ask about them (to discuss these options, you need to complete a separate scope of appointment form).
- Give you written information with a complete description of how the plan works.
During the meeting, Medicare plans and people who work with Medicare can:
- Give you plan materials.
- Tell you how to get more plan information.
- Tell you about the plan options you agreed to discuss.
Q & A about people wanting concise simple answers to complex questions.
People that don’t co-operate, want to buy the cheapest plan and can’t get their employees to fill out the application or pay 1/2
Then make personal attacks!
Late Enrollee for Employer Plans
Medical Loss Ratio 85% Group 80% Individual Plans
We love answering Questions…
BUT some people ask the wrong STUPID ones! Thankfully this woman did not buy from us.
https://medicare.healthreformquotes.com/part-d-rx/aarp/#comment-23968
https://medicare.healthreformquotes.com/medi-gap/blue-shield/#comment-23822
https://medicare.healthreformquotes.com/medi-gap/blue-shield/#comment-23752
https://medicare.healthreformquotes.com/medi-gap/guaranteed-acceptance/birthday-rule/#comment-23763
https://medicare.healthreformquotes.com/medi-gap/guaranteed-acceptance/turn-age-65/#comment-23761
SNAFU – Situation Normal – All Fouled Up
Wikipedia – Including Videos
Steve Shorr
Website Introduction Video
Instant Health Quotes & Enroll
15 Reasons to appoint us as your broker - No extra charge
Our Webpage on Insurance Coverage for
COVID 19
I’ve filed a recent grievance complaint with LA Care because their methods are opaque.
For some reason, none of my out of pocket expenses are being applied to my pharmacy deductible, and I want to know precisely why. Their service center was clueless under questioning.
My specialist co-pays are too high also.
I don’t believe in calling and asking technical questions.
Try looking at your Evidence of Coverage
https://individuals.healthreformquotes.com/appeal-grievances/plain-meaning-rule/eoc-platinum/
I asked you a simple “quick” yes or no question.
Why can’t you just give me a yes or no!!!
I’d love to, but as you know President Trump said Insurance was very complicated and no one knew (except me).
My mandatory annual training for Medicare Advantage also knew and an agent can get in BIG TROUBLE for giving simple answers which may mislead or misrepresent the coverage or how it works.
We are not even allowed to answer the question:
Is this the best plan?
40.4 – Prohibited Terminology/Statements
You can’t Use absolute superlatives (e.g., “the best,” “highest ranked,” “rated number 1”) and/or qualified superlatives (e.g., “one of the best,” “among the highest rank”) unless they are substantiated with supporting data
The superlatives used and the data provided must be in context and may not mislead consumers CMS.gov 2015 * 42 CFR 422.2262, 422.2264, 423.2262, 423.2264, 422.2268(e), 423.2268(e)
How can I visit with my my cardiologist if I don’t have insurance information???
You do have Insurance Information! Here is where your application is shown as pending in my broker portal. We also sent this to you on the 23rd.
There is no requirement to have Insurance to visit a doctor or hospital. If nothing else, put the bill on your credit card and then file a claim. Here’s the form
https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=CLM-14850.pdf
Here’s a form that one Insurance Company requires when applications are submitted late.
I recall when I studied at San Diego State and received a BS in Insurance (see our biography page) one of my professors Mr. Charles Muse, CLU explained that there is no requirement to have coverage to get treated. He just paid and then let the provider send a bill, he would file a claim form.
We also learned that Insurance is for the BIG things that can cause economic disaster that one can’t plan for. Sure, Insurance has changed and now includes preventative care
When you ask the Insurance Company to pay every little thing, it only jacks up your costs. Insurance Companies keep 20% of every premium dollar they take for expenses and profits. It was that way before ACA/Health Care Reform and the ACA made it law. See our page on MLR Medical Loss Ratio.
Under the ACA everything is guaranteed issue. Pre ACA you would have had to fill out complete details of your medical history and then you might have been denied or had your heart condition excluded as a pre existing condition.
That is why, one can normally only buy coverage at Open Enrollment or Special Enrollment, not while you are being admitted to the hospital.
So, in your case, where you lost employer coverage, one needs to PROVE that!
https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=A47614_1-20.pdf
While you applied for coverage on the 10th, you didn’t comply with the requirement to send proof of loss of coverage till the 23rd. Who moves that fast? It took you two weeks to comply, you expect the Insurance Company to finish up everything in a week?
What is your doctor’s email address? I’ll email them and explain the situation.
More on my professor Mr. Chuck Muse, CLU
https://web.archive.org/web/20121017081950/http://www.chuckmuse.org/
https://patch.com/california/lamesa/chuck-muse-candidate-for-helix-water-district-board