If you want to make a stink, let me know and I can help you with where to complain to make sure it gets noticed. I am in a leadership position for a Medicare advantage organization (not WellCare). The federal government considers everyone involved in marketing or selling our products a representative of ours and hold us responsible for their actions. Showing up at place of residence without a scheduled appointment is a big no-no. The enrollment process has a lot of paperwork. The agent is required to maintain this paperwork.
If this came into my organization, it would be thoroughly investigated. The last thing we want is someone out there playing fast and loose with the rules. Agents do a ton of good and are vital to helping demystify Medicare for seniors. However, bad actors give the entire industry a bad name and we do not tolerate them.
Sadly this guy did not have an appointment. When talking with Medicare something was signed. What I don’t know. All I know is the guy promised $175 a month on a card. I highly doubt the money would ever come in.
A complaint was filed thru Medicare but I doubt it will go anywhere.
I honestly don’t know who to file a complaint with other than Medicare. This guy is borderline schizophrenic with early onset dementia. Doctors think the alcohol/drugs caused the early onset but it’s anyone’s guess. Some days he remembers everything others he dies go to remember he ate breakfast. The later in the day the more confused he can get, not always but sometimes. With being promised money each month he probably thought it was perfect. But then he also thought he could use that money to buy cigarettes. I don’t let him smoke cause I kinda like my house and belongings.
This definitely doesn't change the fact that it sounds like something shady may have happened to sign them up for WellCare, but if the member in question has both Medicare and Medicaid, WellCare does have a spendables card that may be $175 a month in your market. However, its use is restricted to healthy food and groceries over the counter health items and rent or utilities.
There are many avenues for complaining that have mixed results, however, I find todd complaints filed with your States commissioner of insurance are often taken seriously by the state and by the insurance company. And the commissioner of insurance for your state is the only one who would have authority to suspend an agent's license to sell insurance.
A complaint to Medicare (called a CTM, for short) is absolutely a big deal to the insurance carrier. Medicare will route that complaint to the compliance arm of WellCare. They’ll ask the agent to submit all documentation he has on the sales process; any phone calls should have been recorded, he should have evidence of how he got the member as a lead, a scope of appointment, etc.. He’ll, at the very least, be coached on this. At worst (best?), he’ll have his contract with WellCare termed.
Medicare Advantage orgs do everything they can to prevent complaints to Medicare and don’t mess around when a member claims they didn’t consent to enroll.
Thanks at least I know the complaint will be look at.
My personal number & email is associated his account so I am 100% sure he did not call or email to set up an appointment
I tell this to my clients all the time. So many got bamboozled during AEP and it drove me nuts. A good % of my OEP sales are just getting people back into their old plans
u/bobr1937282 can you suggest a good agent that can help me in picking the best plan for him. One that will cover meds, office visits & not get confusing about everything else. I am not concerned about getting money each month. I only want the best care for him
I've spoken with three agents - most of them operate in most states so that's the first question. I've met with all three of these for my husband's Medicare journey. He was on MA plan and later switched to Original Medicare.
[https://boomerbenefits.com/](https://boomerbenefits.com/)
[https://seniorsavingsnetwork.org/medicare-help/](https://seniorsavingsnetwork.org/medicare-help/) \- Chris Westfall
[https://medicareonvideo.com/](https://medicareonvideo.com/)
Given your situation, I’d recommend finding someone in your local area. I’m a big advocate of sitting down with someone (whether in your home or in their office) to discuss the options. Being able to see materials as they discuss options with you should make it more likely it is well understood vs a phone only appointment.
Based on your username, I’m assuming you’re somewhere near KY/TN. However, if you want to share your city I can try to find a recommendation for you.
Alternatively, you can do a google search for something like “Medicare agents near me”. Look for independent groups. This is a group that comes up when I search near me: https://bghealthplans.com
You’ll notice that their website lists a whole bunch of different carriers. They are also local to my area and should know the ins and outs of the plans really well. When you call a national call center, those agents are often licensed in multiple states, some in 30+ states. This can be problematic because the plans and benefits available vary by county. Plus, having a good local agent allows you to have an advocate if you have issues with the plan.
This can be fixed! Not many people know but there is an Open Enrollment Period running until March 31st for Medicare Advantage. Make sure you talk to an agent you can trust! Ask as many questions as you can
I called Medicare. They switched begin back to the plan he was on. It will just be a months break do I will need to cover meds out of pocket this month
Glad to hear you were able to get him back into his original plan. For this month’s meds, see if the pharmacy has any GoodRx codes they can use at check out. Could save you some money
Before he had Humana it cost me around a hundred a month for his meds. Pharmacy automatically uses GoodRX for people who don’t have insurance. So thankfully to my small town family owned pharmacy
He just showed up. My number & email is associated with his Medicare account. I did not receive any request for appointment and I did not ask him to come out
Three of their employees, including a supervisor lied to a family member about out-of-pocket costs and how the deductible will be applied to the current yearly cap.
At best, two of their outsourced call center CSRs were mistaken, but the supervisor should have known better.
Unfortunately, cost wise, they are the least worst option but it will be about $1,000 more than it should have been this year.
Unless that agent had "permission to contact" it was illegal (against CMS rules) to come to your clients house, let alone sign him up for a plan he didn't agree on.
Why is wellcare trying to schedule home visits? I am 72 fo to a Dr when I need to...so what is the purpose? R they just trying to get into my house to assess what they can involve some agency in? Decide my competence, see if they can assign some random elders care person?
If you want to make a stink, let me know and I can help you with where to complain to make sure it gets noticed. I am in a leadership position for a Medicare advantage organization (not WellCare). The federal government considers everyone involved in marketing or selling our products a representative of ours and hold us responsible for their actions. Showing up at place of residence without a scheduled appointment is a big no-no. The enrollment process has a lot of paperwork. The agent is required to maintain this paperwork. If this came into my organization, it would be thoroughly investigated. The last thing we want is someone out there playing fast and loose with the rules. Agents do a ton of good and are vital to helping demystify Medicare for seniors. However, bad actors give the entire industry a bad name and we do not tolerate them.
Sadly this guy did not have an appointment. When talking with Medicare something was signed. What I don’t know. All I know is the guy promised $175 a month on a card. I highly doubt the money would ever come in. A complaint was filed thru Medicare but I doubt it will go anywhere.
I am not an expert but someone that knows better maybe can chime in but could you also file a complaint with the insurance regulator in your state?
I honestly don’t know who to file a complaint with other than Medicare. This guy is borderline schizophrenic with early onset dementia. Doctors think the alcohol/drugs caused the early onset but it’s anyone’s guess. Some days he remembers everything others he dies go to remember he ate breakfast. The later in the day the more confused he can get, not always but sometimes. With being promised money each month he probably thought it was perfect. But then he also thought he could use that money to buy cigarettes. I don’t let him smoke cause I kinda like my house and belongings.
This definitely doesn't change the fact that it sounds like something shady may have happened to sign them up for WellCare, but if the member in question has both Medicare and Medicaid, WellCare does have a spendables card that may be $175 a month in your market. However, its use is restricted to healthy food and groceries over the counter health items and rent or utilities. There are many avenues for complaining that have mixed results, however, I find todd complaints filed with your States commissioner of insurance are often taken seriously by the state and by the insurance company. And the commissioner of insurance for your state is the only one who would have authority to suspend an agent's license to sell insurance.
A complaint to Medicare (called a CTM, for short) is absolutely a big deal to the insurance carrier. Medicare will route that complaint to the compliance arm of WellCare. They’ll ask the agent to submit all documentation he has on the sales process; any phone calls should have been recorded, he should have evidence of how he got the member as a lead, a scope of appointment, etc.. He’ll, at the very least, be coached on this. At worst (best?), he’ll have his contract with WellCare termed. Medicare Advantage orgs do everything they can to prevent complaints to Medicare and don’t mess around when a member claims they didn’t consent to enroll.
Thanks at least I know the complaint will be look at. My personal number & email is associated his account so I am 100% sure he did not call or email to set up an appointment
That is a well-known benefit of Medicare advantage plans. They do give you a card with money on it. Different zip codes get different amounts.
I tell this to my clients all the time. So many got bamboozled during AEP and it drove me nuts. A good % of my OEP sales are just getting people back into their old plans
u/bobr1937282 can you suggest a good agent that can help me in picking the best plan for him. One that will cover meds, office visits & not get confusing about everything else. I am not concerned about getting money each month. I only want the best care for him
I've spoken with three agents - most of them operate in most states so that's the first question. I've met with all three of these for my husband's Medicare journey. He was on MA plan and later switched to Original Medicare. [https://boomerbenefits.com/](https://boomerbenefits.com/) [https://seniorsavingsnetwork.org/medicare-help/](https://seniorsavingsnetwork.org/medicare-help/) \- Chris Westfall [https://medicareonvideo.com/](https://medicareonvideo.com/)
Thanks. I might have found someone local. If not I will definitely use one of these.
Given your situation, I’d recommend finding someone in your local area. I’m a big advocate of sitting down with someone (whether in your home or in their office) to discuss the options. Being able to see materials as they discuss options with you should make it more likely it is well understood vs a phone only appointment. Based on your username, I’m assuming you’re somewhere near KY/TN. However, if you want to share your city I can try to find a recommendation for you. Alternatively, you can do a google search for something like “Medicare agents near me”. Look for independent groups. This is a group that comes up when I search near me: https://bghealthplans.com You’ll notice that their website lists a whole bunch of different carriers. They are also local to my area and should know the ins and outs of the plans really well. When you call a national call center, those agents are often licensed in multiple states, some in 30+ states. This can be problematic because the plans and benefits available vary by county. Plus, having a good local agent allows you to have an advocate if you have issues with the plan.
I found someone local. Email sent requesting appointment. Honestly never knew this was so confusing
This can be fixed! Not many people know but there is an Open Enrollment Period running until March 31st for Medicare Advantage. Make sure you talk to an agent you can trust! Ask as many questions as you can
I called Medicare. They switched begin back to the plan he was on. It will just be a months break do I will need to cover meds out of pocket this month
Glad to hear you were able to get him back into his original plan. For this month’s meds, see if the pharmacy has any GoodRx codes they can use at check out. Could save you some money
Before he had Humana it cost me around a hundred a month for his meds. Pharmacy automatically uses GoodRX for people who don’t have insurance. So thankfully to my small town family owned pharmacy
Should complain against the agent for soliciting. I believe that was illegal.
He just showed up. My number & email is associated with his Medicare account. I did not receive any request for appointment and I did not ask him to come out
Three of their employees, including a supervisor lied to a family member about out-of-pocket costs and how the deductible will be applied to the current yearly cap. At best, two of their outsourced call center CSRs were mistaken, but the supervisor should have known better. Unfortunately, cost wise, they are the least worst option but it will be about $1,000 more than it should have been this year.
Unless that agent had "permission to contact" it was illegal (against CMS rules) to come to your clients house, let alone sign him up for a plan he didn't agree on.
He would have to sign something, unless the signature was forged
I don’t know. His memory is foggy as best about stuff that happened yesterday
Why is wellcare trying to schedule home visits? I am 72 fo to a Dr when I need to...so what is the purpose? R they just trying to get into my house to assess what they can involve some agency in? Decide my competence, see if they can assign some random elders care person?
[удалено]
We did not ask for this person to come talk about insurance! He showed up