My 76 y/o mother has been diagnosed with a rare abdominal tumor only treatable in a handful of cancer center across the US. She lives and was diagnosed in North Carolina but we brought her to Florida for a treatment because my wife and I are nurses and can monitor her throughout her treatment then she will return to NC. She is covered by Humana Gold Choice PFFS in NC but just received a letter stating they are cancelling her insurance as of June 30th. Premiums have always been paid on time, there are no other possible cancellation issues except.....the $7000/month cost of the chemo she will require for at least the next 2 years and at least one surgery within the year. Humana is paying only $4600/month and we are paying the remaining $2400/month!! How we will manage this I am not sure but we will somehow...but cancelling her insurance is unethical, cruel and wrong. Going back to Medicare is not an option because she can't afford a secondary insurance (her monthly pension and Social Security is < $1200) nor would anyone give her a policy with this diagnosis. HELP!
Thank you for the post, I am happy to assist you by answering your questions. Was the written explanation for the cancellation? Also, I want to be clear, is it a cancellation or non-renewal?
The letter states The Center for Medicare and Medicaid Services (CMS) confirmed your involuntary disenrollment from the Humana Medicare Advantage Plan. Your coverage will end June 30, 2012. This is clearly a cancellation. I am wondering if they are trying to say she is living in Florida now and that's why they are cancelling but she is only here for treatment and will be returning home within 2 months. We are just watching to see how she manages the chemo treatment
Was there any transaction code in the letter? Perhaps D6?
The letter is signed, sincerely XXXXX XXXXX Team,
Y0040_ gha07xges kc0310. No other numbers or codes on letter.
Thank you, XXXXX XXXXX they are claiming that your mother has relocated out of the service area and therefore falls under a required involuntary disenrollment. This is per Rev. 38, 10-31-03: The cost plan must disenroll a member from the plan in the following cases: • A permanent change in residence out of the plan’s service area (§50.2.1), or a temporary absence from the plan’s service area for more than 90 consecutive days (except as described in §184.108.40.206);Have you responded to the insurer advising that your mother has not relocated, and still maintains her domicile in NC?
Yes we have explained numerous times to numerous Humana talking heads even prior to the beginning of her treatment. We let them know the exact circumstances regarding her being here with us for the initial treatment and all seemed well until they realized the monthly expense and future costs. She just received the letter Friday and she has been here on and off for over 2 months but they just got the Gleevec bill for the month of May of $7000
Thank you, XXXXX XXXXX are probably correct in that the insurance company is attempting to characterize your mother's treatment location as her residence to cancel the policy (and avoid payment). You are correct to notify the insurance commissioner, but also should consider retaining counsel to send the insurer a demand letter challenging the disenrollment and threatening to file suit if necessary to compel reinstatement. Please let me know if you need additional guidance or have any follow up questions.
THANK YOU, XXXXX XXXXX THANK YOU! I will contact you if our efforts fail. You clarified the issues for me making it easier for me to fight them. What a wonderful resource!
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