- 1,255
This is big blue news!
[FONT="]http://www.bloomberg.com/apps/news?pid=20601103&sid=aRIc6VGa.0IQ&refer=us[/FONT]
"Play The Blues For A Beautiful World" – Steve Miller"
CMS Nails WellPoint - Must Read!
- Thread starter MedSuppPro
- Start date
"Play The Blues For A Beautiful World" – Steve Miller"
- Staff
- #2
if you are going to post an article do it right.....
Terms of Service
WellPoint Cut Elderly Off From Medicines, U.S. Says (Update2)
Jan. 12 (Bloomberg) -- WellPoint Inc., the second-largest U.S. health insurer by revenue, has been barred from adding customers to Medicare plans after it denied prescription drugs to the elderly, endangering their lives, the government said.
The sanctions, outlined in a letter to WellPoint today from the Centers for Medicare & Medicaid Services, followed a “sharp” increase in consumer complaints, the agency said. Elderly customers were stopped from receiving essential prescription drugs, and some were overcharged because of computer mistakes, the government said.
“WellPoint’s conduct poses a serious threat to the health and safety of both its prospective and current Medicare beneficiaries,” the agency said in the letter. “The recent failures in WellPoint’s information systems have resulted in beneficiaries not receiving necessary medications at their pharmacies.”
The complaints jumped in the past 12 days, Medicare said. The agency also disclosed the Indianapolis-based insurer’s plans were so flawed that the government in September ordered WellPoint to stop enrolling low-income people. WellPoint told Medicare that computer failures were to blame. Six months earlier, the company lowered its 2008 earnings forecast, attributing the change to problems with its computer systems.
The Medicare sanctions are “definitely not a good thing,” said Carl McDonald, an analyst with Oppenheimer & Co., in New York, in a telephone interview today. “It isn’t as significant now as it would have been a couple of months ago.”
More Than 1 Million
McDonald was referring to “open enrollment,” the period during which elderly customers are free to change plans. That ended Dec. 31.
The shares fell $2.06, or 5 percent, to $38.90 in extended trading today. WellPoint declined 52 percent last year.
WellPoint has about 1.39 million enrollees in plans that provide only drug benefits under what is known as Medicare’s Part D program. Also, 460,000 people are in Medicare Advantage plans that include health and drug coverage. Each Advantage customer generates about $10,000 a year in revenue. The only insurers with more Medicare plan members are UnitedHealth Group Inc. and Humana Inc.
Able to Drop Out
The marketing and enrollment freeze will have no effect on members of WellPoint Medicare plans unless they choose to drop out, or “disenroll,” said Medicare spokesman Peter Ashkenaz in a telephone interview today. That choice is available to people who call 1-800-MEDICARE and request a special enrollment period to choose a new plan by the end of the month, he said.
WellPoint spokesman Todd Siesky said he would try to find someone to comment.
Abby Block, the top CMS managed-care plan officer, said in the letter that WellPoint’s “longstanding and persistent failure to comply” with rules on administering the plans has disrupted enrollment, claims appeals, claims payments and other plan functions.
The company told the government in August that it had “many problems supporting its Medicare Advantage and Part D lines of business,” according to the letter.
According to the letter, WellPoint overcharged for monthly premiums; inaccurately processed enrollments and disenrollments; improperly handled grievances; erroneously rejected claims; and used unapproved marketing materials.
To contact the reporter on this story: Avram Goldstein in Washington at [email protected].
Last Updated: January 12, 2009 19:21 EST
Terms of Service
WellPoint Cut Elderly Off From Medicines, U.S. Says (Update2)
Jan. 12 (Bloomberg) -- WellPoint Inc., the second-largest U.S. health insurer by revenue, has been barred from adding customers to Medicare plans after it denied prescription drugs to the elderly, endangering their lives, the government said.
The sanctions, outlined in a letter to WellPoint today from the Centers for Medicare & Medicaid Services, followed a “sharp” increase in consumer complaints, the agency said. Elderly customers were stopped from receiving essential prescription drugs, and some were overcharged because of computer mistakes, the government said.
“WellPoint’s conduct poses a serious threat to the health and safety of both its prospective and current Medicare beneficiaries,” the agency said in the letter. “The recent failures in WellPoint’s information systems have resulted in beneficiaries not receiving necessary medications at their pharmacies.”
The complaints jumped in the past 12 days, Medicare said. The agency also disclosed the Indianapolis-based insurer’s plans were so flawed that the government in September ordered WellPoint to stop enrolling low-income people. WellPoint told Medicare that computer failures were to blame. Six months earlier, the company lowered its 2008 earnings forecast, attributing the change to problems with its computer systems.
The Medicare sanctions are “definitely not a good thing,” said Carl McDonald, an analyst with Oppenheimer & Co., in New York, in a telephone interview today. “It isn’t as significant now as it would have been a couple of months ago.”
More Than 1 Million
McDonald was referring to “open enrollment,” the period during which elderly customers are free to change plans. That ended Dec. 31.
The shares fell $2.06, or 5 percent, to $38.90 in extended trading today. WellPoint declined 52 percent last year.
WellPoint has about 1.39 million enrollees in plans that provide only drug benefits under what is known as Medicare’s Part D program. Also, 460,000 people are in Medicare Advantage plans that include health and drug coverage. Each Advantage customer generates about $10,000 a year in revenue. The only insurers with more Medicare plan members are UnitedHealth Group Inc. and Humana Inc.
Able to Drop Out
The marketing and enrollment freeze will have no effect on members of WellPoint Medicare plans unless they choose to drop out, or “disenroll,” said Medicare spokesman Peter Ashkenaz in a telephone interview today. That choice is available to people who call 1-800-MEDICARE and request a special enrollment period to choose a new plan by the end of the month, he said.
WellPoint spokesman Todd Siesky said he would try to find someone to comment.
Abby Block, the top CMS managed-care plan officer, said in the letter that WellPoint’s “longstanding and persistent failure to comply” with rules on administering the plans has disrupted enrollment, claims appeals, claims payments and other plan functions.
The company told the government in August that it had “many problems supporting its Medicare Advantage and Part D lines of business,” according to the letter.
According to the letter, WellPoint overcharged for monthly premiums; inaccurately processed enrollments and disenrollments; improperly handled grievances; erroneously rejected claims; and used unapproved marketing materials.
To contact the reporter on this story: Avram Goldstein in Washington at [email protected].
Last Updated: January 12, 2009 19:21 EST
- 18,984
Isn't Wellpoint part of Anthem?
- 14,809
I wonder if those same "computer mistakes" affected their executive's benefits
- Thread starter
- #5
- 1,255
jdeasy, YES!
As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare.
And did you read the SEP part? Call 1-800Medicare!
JD -- Now you can take the rail!
As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare.
And did you read the SEP part? Call 1-800Medicare!
JD -- Now you can take the rail!
Last edited:
- 18,984
jdeasy, YES!
And did you read the SEP part? Call 1-800Medicare!
JD -- Now you can take the rail!
I think I'll pass on that ride.
McDonald was referring to “open enrollment,” the period during which elderly customers are free to change plans. That ended Dec. 31.
The reporters need to get their facts right...
Open enrollment ends Dec. 31
Annual enrollment ends March 31th.
The reporters need to get their facts right...
Open enrollment ends Dec. 31
Annual enrollment ends March 31th.
- 18,984
Actualy, AEP, Annual Enrollment Period, ends on Dec. 31.
OEP, Open Enrollment Period, ends on March 31.
- 1,704
You say tomato I say toe-ma-toe
- 18,984
I know, but, CMS will nail our butt to the wall for getting it wrong. Everybody else is free use it anyway they want.
