I am working with a member who gets his MH benefit from SSA. We have called SSA and confirmed that they have updated his address (back in May). We have also called MH who first told us they could not assist but spoke with someone else and he did say he updated the address in […]
I am looking for advice on how to assist a client who is 73, has permanent residency and does not qualify for Medicare. Her income may put her over the limit for MH standard, and she is not disabled. Another health center’s CAC did a HIX application with her, and it is saying that she […]
Is it possible to get an extension on CommonHealth coverage while DES is reviewing a supplement? A client sent hers back in December (reported by her) and it is still not processed. My facility did not receive the request for records from them until April, so that seems like quite a long time between her […]
If a client has a private POS plan with out of network benefits, will MH secondary pick up the co-pays, co-insurance etc. for an out of network provider?
A CAC at my org. has said that she called MH to enroll a client in a plan after they had become unenrolled recently. MH rep told her that clients who have MH through DTA are not allowed to enroll in a plan, they just have MH standard. Or, she said that the client will […]
from April 11th until today there has been an oddly high number of our patients moving from careplus coverage to standard, and for some, it is unenrolling them from their plan. Is there an explanation for this? If it was just a few I wouldn’t mention it, but it has been about 20-30 people who […]
Is there any word on when the plan enrollment system will actually be working? We have not had any changes successfully processed in over a month. We have also sent paper enrollment forms with no luck. I have now just spent over an hour on the phone with a member calling. When we finally get […]
I am looking for some clarification on a situation I encountered today with a new client. He is married, but him and his wife file separately. His wife has ESI, but he cannot enroll because it is not open enrollment and he is over the 60-day qualifying event period. Does he qualify to be on […]
I am looking for advice on how I can help someone who has cancer. Him and his wife have an income over the limit for any of the buy-in programs, so they have an advantage plan that has some high costs associated. I do not think he will qualify for a Frail Elder Waiver, because […]
Does Masshealth cover the co-pays from part d prescription plans if someone has masshealth as a secondary or senior buy-in?