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Pam Fuchs, EBS in Sauk County, helped a client successfully request retroactive enrollment into her preferred Advantage plan after an agent contacted the client on Facebook and then showed up at her home to enroll her in a Special Needs Plan for dual eligibles (D-SNP) without her consent. The agent even told the client that he “deals with the ADRC." When the client realized that none of her providers were in the D-SNP's network and that she would not have coverage for an upcoming surgery, she called the ADRC Director to complain. The ADRC Director assured the client that the agent was not affiliated with the ADRC and referred her to Pam for assistance, while doing some detective work on her own to learn the agent's name and agency address (and that the local police department had heard about him doing this in the past!). Pam worked with Alyssa Kulpa to file a CTM complaint, which was resolved within 24 hours.
8/30/2023
Story #109
Jennifer helped a client get a dental bill issue resolved. The client has a Medicare Advantage (MA) plan with some dental coverage. She went to a dentist for some covered dental work and was told she would have no co-pay for the services. At the appointment, however, she was told she would have a $400 co-pay. Then, she received another bill for $800. Jennifer helped this client connect with her MA plan who helped advocate for the client with the dentist. The MA plan opened up a fraud case against the dental provider who promptly returned all payments to the client.
Monetary Impact = $1,200
6/29/2023
Story #84
Jodi Kautzer, EBS in Calumet County, assisted a 61-year-old client with her recently deceased husband's outstanding medical bills of almost $12,000. Jodi was doing a benefits checkup for the client when she mentioned that she was feeling stressed about her recently deceased husband's medical bills that were about to go into collections. Jodi contacted her BSSA first to see if it was okay to help in this instance since EBS are typically not able to work with the estates of clients who are deceased. Jodi's BSSA gave permission to assist in this limited circumstance. Jodi discovered that the spouse was eligible for Medicaid at the time services were rendered, but the provider had not billed Medicaid. Instead, the provider was just going to send the bill to collections. Jodi worked the medical provider to verify Medicaid eligibility and advocated to have the outstanding bills correctly billed to Medicaid. Almost $12,000 in medical bills ended up being covered in full.
Monetary Impact = $12,000
2/22/2023
Story #60
Ashley Greene, EBS in Crawford County, recently helped a client regain access to her online bank account so that the client could continue to receive her SSI benefits. The client lost her debit card several months before, and when she tried to request a replacement card online, she accidentally created a second account. Thinking that this could be fraud, the bank put a hold on her account and asked her to send copies of a state ID card and Social Security card so they could verify her identity. Unfortunately, the client had also lost her Social Security card. To make matters worse, SSA sent the client a letter saying that they stopped her SSI benefits because her most recent benefit check had been returned. This left her with no income and no access to any of the money in her bank account. The client set up a new account at a local bank, but SSA could not change her direct deposit information without confirmation of her old bank account routing number. Ashley helped the client set up a MySSA account so that she could request a new Social Security card. That card arrived within a week, and Ashley helped the client send a copy to the online bank. Although customer service said they would reset her account, that still wasn't resolved a month later. Ashley helped the client send additional documentation to prove her identity, and after meeting with the client four times in one week in order to work on this, the client finally regained access to her account. This meant that the client could change her direct deposit information with SSA, and SSA deposited over $3,000 in SSI backpay the following week. Ashley also helped the client file complaints about the online bank with the Consumer Financial Protection Bureau and the Wisconsin Department of Financial Institutions.
Monetary Impact = $3,000
11/30/2022
Story #40