Question about Medicare PPO

I applied for Humana Medicare PPO, and they kept losing my application, finding it, then losing it again. It had a lot of sensitive medical info. I tried calling the agent, and never got an answer. I finally reported them to Medicare.Gov. From here I do not know what to do. I know I have Medicare and part D.
I just got so frustrated as they did not seem concerned at all.
Now it is way past open enrollment. I really needed the Medigap.
Any recommendations appreciated.

Thanks

[LAlkana]

Have you say you reported "them" to Medicare. Do you mean Humana or the insurance agent?

In either case, I would call Medicare ASAP and get their advise on how to fix this. Make certain to take notes on the date/time of your call, what was said, and who you talked to.

As I am under 65, I had some challenges getting a Medigap plan, but finally found one just in the nick of time.

[Redwings]

I applied for Humana Medicare PPO <snip> I really needed the Medigap.

Hi wendy:
A Medicare PPO policy and a Medigap policy are two different things. From the way your post is worded, it isn't clear if you're aware of the differences. A Medicare Advantage plan can supply some of the same benefits as a Medigap policy, but they're not the same, are used differently, and the terms are not interchangeable.

Although the terms might mean the same thing to you, they don't to folks in the insurance business (including Medicare). And if you're trying to straighten out an already confusing situation, misusing insurance terms can only make the confusion worse.

Have you seen this booklet about PPO plans put out by Medicare? http://www.medicare.gov/Publications/Pubs/pdf/11152.pdf

Your best bet may be to call Medicare, explain the situation and see if they can do anything about extending your open enrollment period so you can get coverage under an Advantage plan or a true Medigap (supplemental) policy. Good luck!

[KRISMARK0]

I work in a hospital financial assistance office and I would say 80% of the people who have a Medicare replacement policy (which is what it sounds like you are signing up for) think they have Medicare and this is their supplement. Just make sure you really know what you are getting!

While I can't claim to know a lot about them, I do see the differences in coverage for certain things (mainly inpatient hospital stays). For example the copay of a hospital stay under traditional Medicare is $1132. This deductible is only payable once every 60 days, so if you end up back in the hospital, you do not pay it again.

Humana is probably something like $255/day for days 1-9, then it pays 100%. So, if you are in the hospital for less than 4 days it's cheaper...but if you are there 10 days or more...you pay twice as much as traditional Medicare. I also don't think they have the 60 day rule...if you are re-admitted, I think you pay the deductible again.

I really don't know much about the other benefits though. I suppose better prescription coverage could mean all the difference with expensive meds!

I wish you the best!

[jumpinjiminy]

According to this page, if you've applied during the allotted time frame they can't deny you coverage because they lost an application. I hope you have copies of everything you submitted with dates as proof you applied and when.

http://www.medicare.gov/find-a-plan/...ookieSupport=1

Also, at the bottom of the page, it says to contact your state's office of insurance for help if needed.

Good luck.

[Redwings]

I work in a hospital financial assistance office and I would say 80% of the people who have a Medicare replacement policy (which is what it sounds like you are signing up for) think they have Medicare and this is their supplement. Just make sure you really know what you are getting!

KRISMARK0, thanks for posting.

wendy18, KRISMARK0 brought up the same point I was making. The Humana PPO plan you referred to is a replacement plan for Medicare; it is not a Medicare supplement (or Medigap) plan. While it has little to do with the expiration of the open enrollment period (some states have different rules for Medigap/supplement plans), it IS important for you to understand what you're signing up for.

[Redwings]

wendy18, as this thread develops, it becomes even more important for you to understand what the PPO plan is, and what you tried to sign up for. jumpinjiminy gave a link for good information that applies to Medigap policies. But the Humana PPO plan you said you applied for isn't a Medigap policy, so that information doesn't apply to you (read through it to find out why not). So, as this thread develops, it's even more important for you to contact Medicare, and maybe your state department of insurance, to find out what does and doesn't apply to you, whether there's a PPO/Advantage plan counterpart to a Medigap policy rules, and what help might be available to you.

[0485c10]

I finally reported them to Medicare.Gov. From here I do not know what to do. I know I have Medicare and part D.
Now it is way past open enrollment. I really needed the Medigap.

i think you did the most logical thing you could do & medicare the gov "regulates" unfair practices in selling & management of medicare supplimental plans be it a medigap or an advantage plan...the gov weighed in when advantage plans first began because salesmen were not being truthful in selling them so after the first year there were things the insurance salesperson could not say when selling them---but that might have come under some type of truth in sales laws? I vaguely remember it. i had decided and was shopping for a medigap plan, so the "scandal" didn't affect me.

i hope you made copies of every form you sent in? the date of your application will be the final date so being outside open enrollment should not be an issue...

you just need to be heard, now. Snail mail is much louder than an email, snail mail has exclamation marks in it.

I would send a letter in the mail to the insurance agent. I would send a letter in the mail to humana medicare insurance policies department about my policy not yet being completed despite having started it ? at the bottom of that letter i would cc. the insurance agent. I would send a copy in the mail to both. then i would write to medicare.gov about the problems i am having getting my supplimental plan, at the bottom of that letter i would write cc. insurance agent,Humana medicare supplimental insurance policies... then i woukld send a letter to the state commissioner of inasurance about the issue, the state commissioner of insurance determines which insurance policies can be sold in the state...and at the bottom of that letter i would cc Insurance agent, humana medicare supplimental insurance departmnent. i would make copies and mail them all.

I would keep the letter business like brief &I would sign all the letter with
Regards,
my name.

lets see my plan would mean the
-insurance agent gets 4 snail mail letter from me(1 written to the agent an 3 copies of letters written to others)
-Humana MEDICARE SUPPLEMENTAL POLICY DEPT gets 3 snail mail letter(1 written to humana and 2 copies of letter written to others)
-Medicare gets 1 snail mail letter
-State Commisioner of Insurance gets 1 snail mail letter about the issue.

Means 9 stamps. For mailing address:

http://www.floir.com/

http://www.medicare.gov/navigation/h...ombudsman.aspx

mailing address: http://www.medicare.gov/navigation/h...-medicare.aspx

http://www.humana-medicare.com/humana-contact-us.asp

And make a copy for your self of everything you mail, like i hope you made a copy for yourself of your original application

if you would like a 2nd opinion on the letter you will send, feel free to ask us. when frustrated its very easy to make a letter to convoluted when explaining frustrations--then it doesn't have as much impact if the letter had been business like brief. just pointing to their errors not your frustration. "i have not gotten feed back from an application i made on ? It is passed open enrollment and i find i need to use the insurance coverage now for ?"

[0485c10]

Perhaps add a single sentance "after repeated attempts on my own, i have been unable to get feedback or activation of the policy i signed up for on?" "I am now past the open enrollment and i need to use coverage now". to indicate you worked to resolve the issue on your own without going into frustration of things geting lost and making the letter long & not business like brief.

if humana has good business sense they will call to ask you your experience, so they can improve their service & product. in you letters you do not need to go in great details, just indicate it happened..

[0485c10]

Can i add 1 more thing?

I worked in a male dominated industry in the '80's.
We had to fit into a male working environment.

it was confusing, i bought & read many books on the difference between how men worked and how woman worked.

men treated a positive conclusion as winning a game, did not question it and moved on. why spend anymore time when you got what you wanted???? if they had a negative conclusion to the issue they evaluated everything that was done and made plans to "win" the game next time.

woman had a greater tendency to acknowledge when someone won, someone lost. and if they won they spent time evaluating everything that was done, to explain why it was better this way.

the men do it better. if the situation just gets resolved the way you want it to be resolved,without explanation, don't spend any time questioning why it happened, just move on. You won the game.