Scroll down for a discussion on CMS Nails WellPoint - Must Read! within the Senior Insurance Forum.
[COLOR=Blue]This is big blue news! [/COLOR]
http://www.bloomberg.com/apps/news?pid=20601103&sid=aRIc6VGa.0IQ&refer=us
[COLOR=Blue]
[/COLOR] [COLOR=Blue]"Play The Blues For A Beautiful World" – Steve Miller"[/COLOR]...
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 agoldstein1@bloomberg.net. Last Updated: January 12, 2009 19:21 EST
[COLOR=Blue]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.[/COLOR]
And did you read the SEP part? Call 1-800Medicare!
JD -- Now you can take the rail!
Last edited by MedSuppPro : 01-13-2009 at 10:14 AM.
Reason: Who is WellPoint
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.
This is not a McDonald quote.
I read Peter's statement to mean we have till the end of this month for an SEP.
Not sure why they only have till the end of the month!
Seems this should be SEP for all of 2009. If someone feels they have been wronged they should get an SEP!
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.
This is not a McDonald quote.
I read Peter's statement to mean we have till the end of this month for an SEP.
Not sure why they only have till the end of the month!
Seems this should be SEP for all of 2009. If someone feels they have been wronged they should get an SEP!
You're taking a gamble if you go by what a reporter says. I plan to check with CMS to find out if, in fact, they have issued an SEP for this situation. It may be that CMS has established a one-month SEP for Wellpoint members.
If anyone else finds out the facts from CMS before I do, please post it here with a link to the CMS site you find it.
------------------------------------------------------------------
Review: It appears to me that these errors were for LIS. All LIS beneficiaries have monthly SEP. I missed this in my first reading.
------------------------------------
To be truly independent, an agent should not be dependent on a government bureaucrat for contracts or commissions.
I noticed Blue Cross of Michigan was not showing up on Medicare's website when you listed medications to compare them to other plans. Their MAPD plans and PDP's just aren't there. They're not part of Anthem though, I wonder if Medicare made a mistake and took them off their website thinking they were part of Anthem
The bottom line here is that once again CMS has proven they don't give a crap about seniors. The only MAPD PPO plan in CA is from Anthem. So the choice is many areas would be a Med Supp and PDP for $200+ per month, a PFFS that may or may not be accepted by their docs, or the PPO.
Well now there is no PPO. CMS has not harmed Anthem nearly as much as they have harmed the very people they apparently want to help and protect.
What's that they say about absolute power?
Rick
------------------------------------ ILIAA
Training, Community, Support, and Success Independent Life Insurance Agents Assn rick@iliaa.org
[COLOR=#ff9900]Enroll in Freedom Blue (RPPO) [/COLOR]
January 12, 2009 the Centers for Medicare and Medicaid Services (CMS) ordered Anthem Blue Cross to temporarily suspend enrollment and marketing of our Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP).
We have been working with CMS for several months to resolve issues identified as a result of a recent CMS audit, our own self-audit, and issues stemming from our members’ ability to access their pharmacy benefits. Our plan is to continue working with CMS to make the necessary business improvements in our operations and processes as quickly as possible so that we can re-enter the market in a position to better serve our current and future Medicare members.
The MA, MAPD and Medicare Supplement members we currently serve can continue to count on us to provide their health benefits. We will continue to sell our Medicare Supplement products.
Source: California Anthem Web Site Jan 15, 2009
Note: This web page and the agent email posted on another thread was wordsmithed through the Georgia Anthem regional office. Hum -- that seems a little weird!
Who’s on first and What’s on second!
PS Rick did you read and return the last 09/25/08 "Broker Contract Addendum" If you did, ask yourself who's fooling who about looking out for the client? Look at # 13 "letters to members". Look at #16 Unsolicited Contacts (a. Place any outbound marketing calls to Members... ). And I'm holding back... ( a Frank quote) Don't ya think they saw this coming?
However, I have been paid and still am getting paid on cases that were replaced several years ago! I don't think they have a grasp of their commissions, nor claims. This is not good for anybody!
The true bottom line here is that heads will roll. A little house cleaning is in order!
You're taking a gamble if you go by what a reporter says. I plan to check with CMS to find out if, in fact, they have issued an SEP for this situation. It may be that CMS has established a one-month SEP for Wellpoint members.
If anyone else finds out the facts from CMS before I do, please post it here with a link to the CMS site you find it.
------------------------------------------------------------------
Review: It appears to me that these errors were for LIS. All LIS beneficiaries have monthly SEP. I missed this in my first reading.
-----------------------------------------
Last edited by retread : 01-16-2009 at 05:44 PM.
Reason: Posts merged
CMS Nails WellPoint - Must Read!
Linear Mode
