Today our agency got a call from an upset woman who needed help from a Medicare insurance agent.
She wanted to know if there was any way she could please add us as the Medicare insurance agent of record on her current Medicare Advantage policy.
Upon looking her up in our database, I saw that she contacted us last year. One of my Medicare insurance agent experts helped her do research to find out which plans her doctors participated in. Then on the day of her appointment to enroll with us, she cancelled.
Later on, it turns out, she just applied on her own directly with the carrier.
A Bad Idea
A year later, she is learning all about the woes of applying direct with an insurance carrier and not having a Medicare insurance agent to represent her. She said she had called member services a dozen of times with questions about her coverage. Of course, she kept being transferred or disconnected or left feeling unsatisfied with the answers given.
She needed to know whether her plan required a referral when using her ancillary vision benefit. Also, she wanted to know if it was possible to get a printed directory of all the network physicians in her area. She was fearful of what she would need to do to change her primary care doctor since her current physician is retiring.
In short, she was very sorry that she had not let us help her enroll after all the work we had initially done to help her find the plan. Unfortunately, she can’t add us her agent of record after the fact. So for as long as she stays with that plan, she will continue to be in the same pickle.
Of course I answered her questions for her in less than 30 seconds. In her case, the answers were easy. Most of the time the questions require a call to the carrier, which we can’t do on any policy that is not through our agency. I always feel empathy for someone who learns the hard way about the value that agents bring to the table.
Don’t Go It Alone
We have seen countless examples of individuals who would have been lost without the help of a Medicare insurance agent on their policy. It truly concerns me for the millions of people out there who try to go it alone.
Just yesterday, a Medicare Advantage client’s husband contacted me. He was at his wit’s end with trying to get help from his carrier after his wife’s routine medications got rejected at the pharmacy. He’s the kind of client who doesn’t like to “bother” you without first trying himself. I reminded him to PLEASE call here first so he doesn’t get the run-around when trying to deal with a big insurance carrier’s member services department.
He stated that the pharmacist was being told that the carrier was rejecting her coverage due to a third party. He had no idea what this meant. But I did. Having worked with thousands of consumers on these plans over the years, I immediately knew why. We had a problem that needed to be resolved with Medicare’s coordination of benefits department. I suspected that Medicare may have reinstated information about his wife’s prior group plan coverage. We got his wife on the line and did a conference call with Medicare to figure out the situation.
Sure enough, her former group insurance plan had transmitted incorrect information to Medicare. It told Medicare that she was still enrolled in the group plan even though she had dropped the group last December. Medicare quickly fixed the information in the system. I then explained to my client how to contact his employer’s health benefits department. She needed to get this corrected in their records. Otherwise, the issue was bound to happen again every time the group filed their annual Medicare secondary payer forms with Medicare.
Other Crazy Examples
In a million years, my client would never have dreamed that the reason her medications were not being covered had nothing to do with her current insurance. Instead, the problem was entirely the result of an error at an employer group health insurance plan that she left nearly 9 months ago. She is not alone either. We have assisted folks with some truly bizarre issues over the years.
One client, a lifelong teetotaller, developed unexplained liver failure almost overnight. The plan he had chosen had only a few hepatologists in their network because this field is so specialized. The only one seeing new patients was over 50 miles from his home. He had been to the emergency room 4 times in 2 weeks to have fluid drained from his abdominal cavity while he waited for his appointment.
His friend Jim, who is also my client, urged him to call me for help. We were able to take advantage of a little-known rule about Medicare Advantage plans that allowed him to revert to original Medicare and pick up a Medicare supplement without health questions as long as he did so within the first 12 months of his plans. He was exactly 11 months in. Had he not called us for another month, he would have been stuck. Fortunately, we quickly moved him and got him into a local hepatologist’s office almost immediately.
Medicare Insurance Agent Wins
On another occasion, a couple in their late 80’s contacted our office. Their Medicare supplement company had a series of rate increases, and they were paying more than $450/month for the man’s coverage. He had a few health conditions which had gotten him declined by another carrier. I asked a few questions and identified a carrier with more limited underwriting that I felt might accept him. We moved him to that policy with the exact same coverage for around $315/month.
My all-time whopper is about a disabled 79-year old woman living alone. She shared with some neighbors, who happened to be my clients, that she was paying over $1000/month for her medicare supplement. She was unable to afford her groceries. We visited with her to see what the problem was. In horror, I discovered that over a period of about 11 years, she had first bought one supplement, then another, then another. Ultimately she had enrolled in 5 different Medicare supplements without ever cancelling any of the previous ones. Her worry and fear over coverage had led her to spend tens of thousands of dollars. For over a decade, she had spent thousands on supplements that were duplicates of coverage she already had.
My agency assisted her with cancelling the 4 most expensive plans. We left her on the one plan that covered all her gaps in Medicare for the lowest price. She literally cried sitting with me because was so grateful. I didn’t earn a dime that day in the ordinary sense, but it was the most priceless day of my entire career.
Help from Experts is Available for Free
I urge you to go ahead and do your own research. Educate yourself, and compare rates and benefits and do whatever you need to do to feel comfortable. Of course, an agent can do all of that work for you. But for some people, digesting all this information on their own helps them to learn.
However, when it comes down to signing on the dotted line, please consider asking a licensed insurance agent that works with Medicare products to review with you what you’ve learned. See if you’ve missed anything. Then get the agent to help you submit your application.
It doesn’t cost you a dime, but there may be a time when you have urgent questions. When it does, you will be so glad that you have a person to turn to that is not a nameless, faceless call center employee. There are many of us out here who truly enjoying assisting people.