This is a story about how I had to make and asshole call to a guy that was dying. I’m not sure if this nationwide but at least where I live if a person has ESRD they aren’t able to switch Medicare advantage plans ever… They find one and stick with that forever I’m sure if they move out of the service area there’s an exception but for this one this isn’t the case.
So this guy had called in during annual enrollment period stating he was termed for nonpayment and wanted to reenroll. Now ESRD patients aren’t that common so I go through the WHOLE application (which takes forever in itself) and when I get to the questionnaire portion I ask if he has ESRD and he replies with yes. Now I’m sitting her like 🥺. So I let him know we might not be able to process his application because of that and I’ll call him back. So we reach out to enrollment and nope we can’t enroll him, the system that’s connected with CMS will just automatically term him even if we did accept it.
So I had to call him back and let him know that he no longer has health insurance because he has ESRD and he can’t just go to another company either. All he can have for the rest of his life is original Medicare and a stand-alone pharmacy plan. If you know anything about health insurance dialysis is fucking insanely expensive. I have seen claims with members paying 10k+ when they only have to pay 5% of the bill and this man now has to pay 20%. I felt horrible.