Over the years, we all have our customer situations that stand out, and we remember. As my first client with Sapoznik Insurance, a World Company, and a referral from a partner agency, this one was particularly memorable. One of the things that attracted me to this organization is its dedication to its clients year-round. In the event of a crisis, we fight for our clients, and seeing it firsthand was terrific.
A new client had reached out for guidance in removing an employee’s spouse from the group health plan who was eligible for Medicare. This was a no-brainer; I’ve been working with Medicare for longer than I care to admit. I knew the steps to take. We spoke with the employee, and just like that, they were enrolled into Medicare, saving $800 a month in premiums. So, we thought.
Each carrier has its state regulations and systems. Usually, it is an endless cycle of 1-800 numbers and emails while crossing your fingers in the hopes someone will call or email you back. In this carrier’s case, they only communicate via email with little information and no timelines. To make matters worse, due to the security measures, many emails end up in spam, mine included. This carrier’s process does not include a phone call to confirm that the beneficiary was removed from the group plan. I try not to deal with carriers that don’t have a set process with a contact person with whom I can develop a relationship. But I digress.
Several months later, I received a panicked call from the owner. He informed me that he had been back billed from the insurance carrier for the employee’s spouse, who we had moved to Medicare six months ago, causing a lot of stress for this small business owner.
So, what happened?
Of course, when I received the call, I was at the car dealership dealing with my own issues and ready to hit the road on a jammed-packed day of meetings. Urgency kicks in, and I immediately re-prioritized my day. Anyone who has dealt with Medicare knows that timing is everything, and if not handled with urgency, it can lead to bigger problems. It is like a row of dominoes that you have lined up perfectly, and someone comes along and taps the first one to fall.
I return to the office to coordinate with one of our passionate Client Managers, Monique, and “team up to clean up.” Since this carrier doesn’t directly deal via phone, we had to send an email with a deadline of 24 hours to rectify the situation. If not, we would advise our client to move forward with another company. Monique is diligent and proactive; she attached every single document and all the billing issues to expedite the process. Sometimes you need to flex your muscles to increase the urgency. No one likes to lose business, and this carrier was on the verge of it.
Shockingly they called before the end of the business day. We conferenced our client, so there was no stone left unturned. Since this situation was escalated to a manager, we wanted our client to be on the phone, so he had the opportunity to express the hardship and frustration this caused him as a small business owner.
We had the situation resolved and a happy client once again in less than 24 hours with the credits they were due.
The issue stemmed from the carrier. The carrier had not removed the person in question from the policy although they had the paperwork in hand with ample time to do so. It was an oversight Luckily, it was caught before the person who moved to Medicare had a claims issue. Had there been a medical issue, or a pharmacy claim, Medicare would have rejected the claim as the person in question would have shown up as being active on the group policy. Had this happened, this would have set off another domino effect.
Mistakes happen. We are only human. The key is to have an advocate on your side, act immediately, follow up and follow through. My clients are a top priority, and while I do not like to reschedule meetings or calls, they are incredibly understanding when an issue arises because they know I would do the exact same thing for them.
Written by Joy Sexton, Benefits Consultant, Sapoznik Insurance, a World Company