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Drug plan answers often wrong

Government investigators make 900 calls to 10 drug plan sponsors. They say they got complete, accurate responses only a third of the time.

By TOM ZUCCO
Published July 10, 2006

When Glenn Paul called Humana to find the cheapest price for about 15 Medicare prescription drugs he and his wife need, he waited on the line about 30 minutes and then got the numbers for five drug carriers.

No one answered one of those numbers, and contacting the rest took half a day.“They (Humana customer service reps) are very polite,’’ Paul, 70, said Monday from his home in Indian Rocks Beach.

“But they’re not consistent. You won’t always get the same answer. ... And some honestly don’t know. My hunch is they’re not fully trained yet.’’

His hunch sounds right.

According to a report released Monday by the Government Accountability Office, seniors often receive bad advice from private insurers when asking about a Medicare drug plan.

Many of the 43-million people eligible for Medicare drug coverage rely on insurers’ call centers for information about what plan would best meet their needs. In March, GAO investigators made 900 calls to 10 of the largest drug plan sponsors.

They said they got complete and accurate answers only a third of the time.

“Our calls to 10 of the largest (drug plan) sponsors’ call centers show that Medicare beneficiaries face challenges in obtaining the information needed to make informed choices,” concluded the GAO report.

The overall accuracy and completeness rate ranged from 20 percent to 60 percent. Only one insurer gave the proper, full answer more than half the time.

The investigators did not identify the insurers by name. They said call centers answered the large majority of calls with minimal delay, were courteous and often offered helpful suggestions. Yet they were unable to answer 15 percent of the questions posed. Further, different operators within the same call center sometimes provided inconsistent answers.

Officials with the agency that oversees the drug program disputed the analysis. They said it was based on “inaccurate, incomplete and subjective methods” that limit the report’s validity. But the GAO maintained its methods were sound.

Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, said investigators asked customer service reps for information that they are not required to provide, and may even be prohibited from providing.

“Medicare has never required drug plan call centers to provide detailed information about the prices of specific combinations of drugs,” he said. “Despite this fact, two of GAO’s five questions were on this topic.”
That explanation didn’t satisfy Democrats who requested the study.

“The lack of accurate and understandable information for our seniors has been a chronic problem since the beginning of Medicare Part D,” said Rep. John Dingell, D-Mich., ranking Democrat on the House Committee on Energy and Commerce.

“Senior citizens are being hurt by the indifference and incompetence of the Bush administration and its friends in the insurance industry.”

Under the program, which began Jan. 1, private insurers administer the benefit. The federal government subsidizes the cost. Across the country, there are more than 1,400 standalone drug plans. Beneficiaries typically can choose from 40 to 50 offering coverage in their states.

The deadline to enroll in the program without penalty passed for many beneficiaries on May 15. The report Monday prompted some Democratic lawmakers to call on the Bush administration to give seniors and the disabled another chance this year to switch plans, much like the poorest of beneficiaries are already allowed to do.

“People who received inaccurate or incomplete information shouldn’t have to remain in the wrong plan or go without coverage for the rest of the year,” said Rep. Pete Stark, D-Calif.

McClellan said that beneficiaries who believe they’ve been misled do have some recourse. He said they should call the insurer first. If that doesn’t resolve the conflict, he suggests they file a complaint with his agency.

“All they need to do is complain to us that they thought they were getting one thing and they are getting something else in their plan,” McClellan said.

Most of the largest insurers offer more than one drug plan to Medicare beneficiaries. Investigators asked operators to identify the plan that would be cheapest, based on the medicines involved.

However, operators at three calls centers told the investigators that it was against the insurer’s policy to identify the plans that have the lowest costs. Other operators at the same call centers identified a plan as having the lowest annual cost.

Often, when operators did find the lowest-cost plan, they misstated what the true costs would be. For beneficiaries with low drug use, the operators tended to quote costs that were higher than they actually should have been. And, for beneficiaries with high drug costs, the reverse occurred.

The trade group representing insurers also assailed the GAO’s report as seriously flawed. Investigators asked for help that customer service representatives should not be giving according to federal regulations, it said.

“They cannot choose or indicate to a particular beneficiary that Plan A is better than Plan B or C,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans.

Accusations of bad advice aren’t limited to the insurance companies. The GAO found in May that Medicare’s operators also gave callers false or incomplete information.

Investigators placed 500 calls to Medicare’s information hotline and found that about a third resulted in faulty information or none at all.

Information from Times wires was used in this report.

[Last modified July 10, 2006, 21:40:37]