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After Audit, Insurers Vow to Improve Medicare Service
By Robert Pear, The New York Times
October 10, 2007
Health insurance companies cited by federal auditors for violation of
Medicare standards said Tuesday that they were addressing the
deficiencies and would improve service to patients, who will be able to
switch plans in the last six weeks of the year.
The commitments came as Senator Barack Obama, Democrat of Illinois, and
two other members of Congress expressed concern about the marketing of
private Medicare plans and their handling of claims, appeals and
grievances.
Carolyn P. Haynes, a compliance officer at WellPoint, one of the
nation’s largest insurers, said the company had hired additional
employees to answer telephones and pay claims filed by or for Medicare
beneficiaries.
Ms. Haynes said WellPoint was reducing its claims backlog and telephone
waiting times and expected to be in compliance with federal standards by
the end of this month.
Pamela Mariea-Nason, public policy director at CareOregon, based in
Portland, said her company was “very serious” about correcting
deficiencies and was revising its procedures.
CareOregon, which serves low-income people enrolled in both Medicare and
Medicaid, questioned the wisdom of one recommendation, involving notices
to beneficiaries about the denial of claims. “To send all these notices
could confuse and scare our patients,” Ms. Mariea-Nason said.
Coventry Health Care, which recently had a civil penalty of $264,000
assessed for violation of Medicare marketing standards, said it had
taken steps to prevent a repetition of the problems.
Cathy B. Campbell, a spokeswoman for Coventry, said the company had
retrained its agents and changed the timing of commission payment to
discourage inappropriate sales.
Mr. Obama, a candidate for the Democratic presidential nomination, asked
the Government Accountability Office to investigate violations by
private plans.
Senator Max Baucus, Democrat of Montana and chairman of the Finance
Committee, said, “The unscrupulous tactics of some plans have led me to
be skeptical about how well this market works for seniors.”
And Representative Pete Stark, a California Democrat who is chairman of
the Ways and Means Subcommittee on Health, asserted that the Bush
administration had had been reluctant to “regulate or offend these large
companies.”
But Kerry N. Weems, acting administrator of the Centers for Medicare and
Medicaid Services, said “contract compliance and beneficiary protection”
had been among his top priorities since he took office last month.
Karen M. Ignagni, president of America’s Health Insurance Plans, a trade
group, said the audits did not reflect the fact that private plans
“generally offer better benefits” than original Medicare.”
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