Question; I changed my insurance for the first of the month. I got a ‘welcome to the plan’ letter, but nothing more. I needed new medications but the pharmacy said my ID information doesn’t work. What should I do?
Answer; This is a problem that can happen anytime you change insurance products. We have moved to a society where information is communicated through computers. Sometimes that exchange of information is immediate. Sometimes that communication does not go well. I believe this may have happened in your case.
Most individuals enroll into their insurance products using a website like www.medicare.govor the website of the insurance company you choose. This website takes the information you enter and sends it to the appropriate department, which is another computer. This computer processes your application and generates the appropriate letter and documents you need about your plan. The majority of the time this happens correctly and seamlessly. When it doesn’,t it can be difficult to correct and even more difficult to figure out what happened.
Let me give you an example; You changed your insurance in January using the Medicare Advantage Open Enrollment Period. This January change (enrollment) would enact your new coverage to begin 2-1-19. It is February, so you went to the pharmacy and the new coverage wasn’t in their computer. Obviously, you had to give the pharmacy the new insurance information. Once you gave the pharmacy the information, the insurance coverage was denied.
The first thing I would recommend doing is call the new insurance company. The information is on the letter and it is also available on your enrollment document. When you enroll online or even over the phone, you are given a confirmation number. This confirmation number can be used to track your enrollment. Try tracking your enrollment and see what has happened.
I have been involved in situations where there is missing information, or maybe mistyped information. Once you correct this error or give the company the missing data, you can get your prescriptions.
I have also been involved in situations where an application has been denied incorrectly. This may require a little more work, as you may have to prove you had the right to enroll into this plan, which usually involves understanding the Enrollment Periods available. In this situation, your new insurance company may say “Medicare denied your enrollment.” You may have to call 1-800-Medicare, and speak with their customer service people to get this type of mistake corrected. Medicare customer service representatives are much more aware of the more than 20 Special Enrollment Periods (SEP’s) available, as well as the other types of Enrollment Periods. We are currently in a brand new Enrollment Period, called the Medicare Advantage Open Enrollment Period. This runs from January 1stto March 31stand allows anyone with a Medicare Advantage Plan to switch their insurance to anything else they wish.
Calling 1-800-medicare customer service, you can be confident that your problem will be fixed or at least understood and can set up a plan for correction. You will need your Medicare card information, and ideally, that confirmation number before you make that call. Remember that people call 1-800-medicare for a variety of reasons, so there is a message you have to listen to, and a number you will need to press to get to the appropriate department.
Once you figure out what happened and why your insurance didn’t work, you can find out how to correct it, and the timeline for correction. Sometimes that can be corrected immediately and you are all set. Sometimes there is a bigger delay. Work with your pharmacy on your medications. Sometimes they can give you a smaller number of pills to last part of the month while your situation gets corrected. Sometimes you have to pay cash and the claim is resubmitted once the insurance is enacted and you can get your payment back. You could also see if samples are available from your physician if it is a name brand medication.
Don’t EVER use the old insurance card to cover the medications. I have found using your old insurance card will really mess up the process. Using your old card may reinitiate the insurance you don’t want anymore, or in other words, reactive the old insurance. If you left that insurance coverage because you found something better, you don’t want to reactivate it.
Of course you can also reach out to the individual or agency that helped you find that new insurance product. They may have some information, experience or a contact who can figure out what happened. I know I have spent much of January and now maybe February working on those kinds of issues!
I sometimes feel like this process doesn’t work, but I know it does. The vast majority of individuals transition from one product to another without any problems. I rarely hear from those people. I hear from the individuals where the process didn’t go well and need help fixing it.
To contact Janell Sluga, GCMC with questions or concerns, please call 716-720-9797 or e-mail her at firstname.lastname@example.org.