Health plans will stop marketing private fee plans

Filed under: Health Care |

In response to concerns about marketing practices in the insurance industry, seven health care sponsors have agreed to suspend marketing of private fee for service plans.

United Healthcare, Humana, Wellcare, Universal American Financial Corp., Coventry, Sterling and Blue Cross/Blue Shield of Tennessee signed the agreement with the Centers for Medicare and Medicaid Services.

“While we note that most health insurance agents are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors that need to be removed from the system for good,” said Leslie Norwalk, acting administrator of CMS. “This voluntary agreement demonstrates that CMS and the plans are stepping up to ensure that deceptive marketing practices end immediately, and that beneficiaries understand what they are purchasing.”

CMS received 2,700 complaints about agents from December through April, Norwalk said. Many of the complaints were about the Medicare Advantage program, the most expensive Medicare supplement.

The agreement is effective today and will continue to apply until the plans demonstrate that they have the management controls to meet all requirements.

“Plans signing the agreement will be actively monitored to ensure they do not engage in marketing while the voluntary suspension is in place,” Norwalk said. “Violations will be subject to full range of available penalties, which include suspension of enrollment, suspension of payment for new enrollees, civil and monetary penalties, and the termination of the plan’s involvement in the Medicare program.”

All private fee for service plans must meet several criteria before the suspension is lifted:

  • All advertising, enrollment and sales materials must include disclaimer language provided by CMS.
  • All representatives selling the product must pass a written test to demonstrate their thorough familiarity with both the Medicare program and the product they are selling.
  • A provider outreach and education program must be in place to make sure providers have reasonable access to the plan’s terms and conditions of payment. Provider relations staff must be accessible to assist providers with questions about the plan.
  • Outbound education and verification calls must be made to all beneficiaries requesting enrollment to make sure they understand the plan rules.
  • Planned marketing and sales events must be sent to CMS and will include events sponsored by delegated brokers and agents, as well as those sponsored by the plan.
  • Plan sponsors must provide a complete list of all representatives marketing a private fee for service product and authorize CMS to make that list available to state insurance departments upon request.

CMS also started a corrective action plan, which will remain in place for the companies. Norwalk said the government agency also will monitor performance of the plans, once marketing has resumed.

Groups call for IT legislation

Three groups, representing more than 50 million Americans, have called for health information technology legislation in Congress.

AARP, Business Roundtable and the Service Employees International Union launched the “Divided We Fail” campaign to urge lawmakers to address health care information technology “immediately” to increase safety and efficiency.

The groups say that they believe health IT will be a critical building block for broader health reform.

The groups are calling for a secure, uniform, interoperable system that will save time, stress and money.

During 2005, a report published in the Journal of the American Medical Association found that as many as 98,000 Americans die each year because of medical errors.

During that same year, more people died because of medical errors than from Alzheimer’s, HIV, automobile fatalities, suicide, homicide or hypertension.

Another study estimates that medical errors cost the nation about $37.6 billion each year; about $17 billion of those costs are associated with preventable errors.

The groups are asking Congress to pass a bill that provide grants, loans or tax credits for providers to help with purchasing interoperable health IT systems.

Cigna earns ‘excellent’ accreditation

Cigna HealthCare has earned “Excellent” accreditation — the highest accreditation rating possible from the National Committee for Quality Assurance for its commercial HMO and point-of-service health care plans in Illinois, Indiana, Ohio, Arizona, Colorado, Kansas/Missouri, Texas and St. Louis.

The NCQA Accreditation survey process includes onsite and off-site evaluations of more than 60 standards and selected performance measures, conducted by a team of physicians and industry experts.

The “Excellent” status is effective for three years.

The review process evaluates how well a health plan manages its operations and the extent to which it works to improve health care for its members, in addition to its relationships with medical providers.

NCQA accredits and certifies a range of health care organizations and recognizes physicians in key clinical areas.

Amy Gillentine covers health care for the Colorado Springs Business Journal.