Agencies struggle to connect
By SUZANNE PALMER
Published June 3, 2007
A recent column about dealing with Medicare Advantage programs really resonated with a lot of readers. In the past couple of years, I've amassed a thick folder of letters from readers pleading for help to straighten out deductions and reimbursements for health care coverage.
"My wife is owed $973.50, " wrote Steve Krashnyk of Port Richey.
"It is going on six months now, " said Edith Wasell in Brooksville, "and all I am getting is the runaround."
New Port Richey's Murrell Ewing was waiting for a little more than $960 last November.
"I have contacted the Centers for Medicare and Medicaid Services, the Social Security Administration and (my private insurer). All say it's not their fault, " said Rose Taladay of Riverview.
Letter after letter told similar stories of frustration and endless excuses. Many readers have never received promised reimbursements.
Medicare Advantage plans were created by the 2003 Medicare Modernization Act. Drug plans were added in 2006. The plans allow seniors to use private insurers for their health care, increasing their coverage. The federal government pays the insurers a set fee per member per month.
As a selling point, insurers offer to reimburse members their Medicare Part B premium, increasing their monthly Social Security checks.
Here's how it's supposed to work. Members enroll with the insurer of their choice. The insurer sends enrollment information to Centers for Medicare and Medicaid Services (CMS), and CMS sends deduction and/or reimbursement information to Social Security.
The plans are popular, and the organizations involved seem to have been unprepared to deal with the demand for service. Computer problems at CMS dropped or never reconciled coverage for thousands of Medicare recipients.
The buck seems to stop at CMS, if the insurance companies are submitting enrollment information in a timely manner for the most part. Social Security can't make any changes to a recipient's withholding until it receives an alert from CMS, said Judy Geier of the SSA in St. Petersburg. Those alerts apparently aren't reaching Social Security, because CMS has had computer problems and its computers don't speak the same language as the Social Security computers. Recipients can call Social Security, but the agency can only report the problem to CMS.
There are about 28, 000 Medicare recipients who have joined an Advantage plan who are still owed refunds, according to Lee Millman, spokesperson for CMS in Atlanta. Millman said that once the computer problems were identified, the agency began a series of "reconciliations, " or checks, to make sure all the enrollees' statuses were correct. The last reconciliation occurred in December, and Millman expects another this summer. Those still enduring errors should call toll-free 1-800-Medicare (633-4227). "Tell the representative what's going on, " Millman said, "where you live, how much money you're owed and how long (the problem) has been going on."
Many readers say they've done that, with little or no success.
There is help
SHINE (Serving Health Insurance Needs of Seniors) is a service of the Florida Department of Elder Affairs and the Area Agency on Aging. Its trained volunteers offer Medicare recipients help on many topics, especially Medicare Advantage plans. Call the Elder Helpline toll-free at 1-800-963-5337.
You might also try contacting your congressman or congresswoman. Visit www.searchgov.com and click on the corresponding branch to find information. Sending your complaint by post or e-mail allows their offices to track the type and number of complaints, whereas a phone call may fall through the cracks.
Action has been unsuccessful in getting responses, much less resolution, for the many complaints it has submitted to CMS.
Action solves problems and gets answers for you. Write Times Action, P.O. Box 1121, St. Petersburg, FL 33731, or call, (727) 893-8171, or, outside of Pinellas, toll-free 1-800-333-7505, ext. 8171, to leave a recorded request.