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Senior gets 'slammed' from Medicare

A Tampa retiree worried about rising drug costs wound up in a private Medicare plan that left her with unpaid doctors' bills.

By KRIS HUNDLEY
Published April 25, 2005

TAMPA - Virginia Deutsch had just been complaining to her daughter about a rise in prescription costs when a young man knocked on the door of her tidy green mobile home in mid January.

Would Deutsch, 76, be interested in learning about a way to get all her drugs for free?

Little did the Tampa retiree know that she was about to be "slammed" into a private Medicare plan that would leave her with unpaid doctor bills and considerable anxiety.

In the world of Medicare HMOs, now called Medicare Advantage, Hillsborough County seniors like Deutsch are worth $688 a month. That's how much private insurers are reimbursed by the federal government when they take retirees off traditional Medicare and assume responsibility for their medical costs.

With government reimbursements to insurers rising - up 16 percent over a year ago in Hillsborough - the number of companies offering such plans has multiplied and the competition for members like Deutsch has been heating up.

In Hillsborough, four companies offer 11 alternatives to traditional Medicare. Though the federal government strictly regulates how the plans market themselves, Deutsch's experience may best be seen as a cautionary tale of what can happen when those regulations aren't closely followed.

Door-to-door soliciting, for instance, is banned, and while Medicare and insurers say "slamming" patients into new health care plans without their full knowledge is rare, the case of Virginia Deutsch suggests it happens.

"We see quite a few patients who have no clue they've been changed to an HMO," said Kendra Perez, who handles billing for Dr. Kevin Sierra, a Tampa lung specialist. "They'll tell me, "Somebody came out to my house and said if I signed a paper, I'd get better prices on prescriptions.' They're not thinking their actual Medicare is changing."

When Deutsch showed an interest in the cold-caller's pitch, the young man said he'd return the next day with his boss who was more knowledgeable about the program.

So on Jan. 18, Deutsch and her daughter, Judy Tawes, spent about an hour listening to a sales spiel for WellCare Medicare Advantage from Rick Husted, a salesman with the Tampa HMO since March 2004.

Husted, accompanied by the sales trainee who had first knocked on Deutsch's door, told the women about the many benefits of WellCare's Advance plan. Most enticing: no charge for generic or brand drugs.

Deutsch, a firefighter's widow from Evansville, Ind., had always relied on traditional Medicare plus a supplemental policy through her husband's former employer to cover medical costs. That arrangement worked well through the years. But Deutsch learned in January that the Medigap policy had raised the copay for drugs.

Instead of paying $6 for a three-month supply of generic drugs, she was going to have to pay $20 per prescription. The copay for brand drugs, meanwhile, jumped to $60 from $15. For a woman with Deutsch's medical history - and a daily regimen of 16 different drugs - the increase had a sizeable effect.

"When I ordered my prescriptions at the first of the year, I was told I owed them $480 more," she said.

So Deutsch was understandably interested in WellCare's generous benefits. But she was cautious, especially when Husted told her none of her doctors were part of WellCare's network. Because of several serious medical problems, including ongoing treatment for thyroid cancer and severe asthma, Deutsch said she told Husted she was unwilling to change doctors.

"I told him I couldn't do anything now because I've got to make sure my bills are paid for," said Deutsch, who is still receiving bills for hospitalizations in October and November. "I said there was no way on earth I was changing my insurance now."

Husted, who refused to comment for this story, suggested a compromise, according to Deutsch and her daughter. If Deutsch would sign the application form, Husted promised to hold it until she gave him the go-ahead.

"He said he would not turn the enrollment form in until we told him to," Deutsch said. "And at that point he'd come out again to fill out another paper."

Husted, 63, left Deutsch with a copy of the signed enrollment form, his business card and a nervous feeling in the pit of her stomach.

The next day, her granddaughter called Husted, who reassured her that Deutsch's enrollment form was sitting on his desk. The next week, feeling unsettled about the incident, Deutsch had her granddaughter fax WellCare, saying she wanted to stay in Medicare.

Thinking the episode was over, Deutsch visited her internist and asthma specialist as usual in February and March, having routine blood tests. It wasn't until she got a call from her specialist's office that she learned her traditional Medicare coverage was no longer in effect. Official records showed her to be a member of WellCare's HMO, effective Feb 1.

Deutsch, soft-spoken and nervous, still seems stunned.

"He told me he'd hold the papers and not turn them in," she said. "He didn't do that."

After learning she'd been switched to WellCare, Deutsch called and wrote Medicare to complain. Her granddaughter called WellCare, which claimed never to have received Deutsch's original cancellation notice. Another cancellation request was faxed, along with the granddaughter's plea.

"This is a very urgent matter she is in a panic that she will have to come up with all the money her self to pay her doctors and that they will refuse to see her," Karen Figueroa wrote on her grandmother's behalf. "She has a lot of Medical problems that she needs to see her doctors."

On April 1, Deutsch got a letter from Medicare, assuring her that she was back on the traditional program. Her Medigap coverage, for which Deutsch pays $40 a month, had never lapsed.

Donna Burtanger, a spokeswoman for WellCare Health Plans Inc., said her company has stringent regulations for its sales reps, who must be licensed and undergo extensive background checks.

Burtanger said WellCare's salespeople are paid a combination of salary and commission. If a member drops out within 90 days of enrollment, no commissions are paid. "So there are some checks and balances in the compensation structure," Burtanger said.

"This is the first marketing complaint I've heard and I've been here two years," she said. "They are very unusual for us."

Burtanger said Husted has no disciplinary actions in his file. But she said an internal investigation was being launched on the basis of Deutsch's complaints.

"There's not a whole lot confirmed right now," she said. "But if the accusations are founded, then disciplinary action will occur, right up to and including termination. We take these things very seriously."

Burtanger speculated that Deutsch's first cancellation notice, in late January, may have fallen through the cracks since she was not in the WellCare system. But the company's spokeswoman had no explanation for why a cold-caller would be trolling a mobile home park for WellCare customers.

"That is not allowed," she said. "That is very disturbing."

Deutsch, meanwhile, has written to a special Medicare contractor to see if medical bills incurred in February and March might be covered retroactively. And she's decided she'll be more cautious about contracts in the future.

"If anyone comes to my door now," she said firmly, "I'll just shut the door in their face."

Times staffer Anne Arsenault and Times researcher Carolyn Edds contributed to this report. Kris Hundley can be reached at 727 892-2996 or hundley@sptimes.com

[Last modified April 22, 2005, 22:23:02]