As of August 2007, the Centers for Medicare and Medicaid Services (CMS) cut off callers’ access to Medicare Carriers, Intermediaries, and Medicare Administrative Contractors (MACs). With this new change, advocates and beneficiaries alike have no direct access to these centers for claims and payment investigations. Lack of direct access equals further delays in resolving disputes, and in some urgent cases can put a person’s health in danger. For example, recently a beneficiary with a kidney transplant was unable to get his immunosuppressant drugs due to a Medicare billing glitch. This glitch could have been easily handled with a quick phone call to Medicare’s Part B Carrier, and instead took over three months to resolve, jeopardizing this man’s access to his immunosuppressant drugs and therefore his health and health of his kidney transplant.
With blocked telephone access to Medicare’s claims contractors, instead of 1-800 Medicare being able to connect a caller to the claims contractor, the Medicare customer service representative (CSR) now either attempts to handle the complex questions that normally require resolution by the appropriate contractor, or emails the appropriate claims contractor about the caller’s inquiry. The caller will then hopefully receive an email or phone call from the contractor in a timely manner. If the caller is on the other line or away when the contractor returns the call, the caller again has no way to return that call. S/he can only wait and hope the contractor will call again. Contractors can not leave a return phone number or email address for the beneficiary or advocate to use.
For advocates whose phone lines are often busy, or beneficiaries who are away from home during the day, this change in phone access greatly slows and sometimes halts efforts to resolve billing errors, disputes and other complex cases. In urgent situations, the communication turn around may be at least 2-3 days and a return call is not even guaranteed. Sometimes contractor staff attempt to resolve the issue emailed to them by 1-800 Medicare without calling the advocate or beneficiary back directly. In these cases, the advocate or beneficiary must call 1-800 Medicare again to find out what action if any has been taken on their case. Other times, often with complex cases, the information 1-800 Medicare reports to the contractor may not be accurate which causes further delays in case resolution.
In the past, each carrier, intermediary, and MAC had their own phone numbers available to advocates and beneficiaries. Beneficiary call numbers were also printed on their Medicare Summary Notices (MSNs) and Medicare instructed beneficiaries to use these numbers for resolving any claims questions or disputes. A couple years ago, in an effort to ‘centralize’ operations further, Medicare had all it’s claims contractors stop these direct lines and instruct people to call 1-800 Medicare instead. While making access a bit more inconvenient for callers, who had to first call 1-800 Medicare and then be transferred to the appropriate claims contractor, advocates and beneficiaries could still reach these contractors by phone. They could talk with a “live” person, someone who handles claims daily and knows the Medicare billing codes, and could usually get questions answered.
As mentioned above, this new change in access is both inconvenient and, in some cases, can put people with urgent disputes in peril. In last edition’s article on Senator Smith’s concerns with 1-800 Medicare, both Senator Smith and his staff and a recent Office of Inspector General report (PDF) pointed out numerous concerns with quality and efficacy of service and accuracy of information provided by 1-800 Medicare customer service representatives. On March 5, 2008, Senator Smith also sent a follow-up letter (PDF) to CMS Acting Administrator, Kerry Weems, regarding ongoing customer service problems with 1-800 Medicare that also includes details on nine specific complaints received just this past week. Several of these complaints were reported by California’s Health Insurance Counseling & Advocacy Programs (HICAP).
Senator Smith’s office is continuing to track these problems/complaints with 1-800 Medicare and asks that you and/or your clients forward such complaints to the Senate’s Special Committee on Aging’s Tipline. Senator Smith is currently the Ranking Member of this committee which review’s Medicare’s performance on an annual basis, conducts oversight of programs, investigates reports of fraud and waste and makes recommendations for legislation. The Tipline provides an easy way to receive complaints about fraud, waste and abuse in the government’s programs. People can submit as little or as much information as they choose about their complaints with 1-800 Medicare with the Tipline’s online form, and all submissions are confidential. People without access to the internet can contact Senator Smith’s staffer, Chris Hinkle directly at 202-224-8703.
Note that the Tipline is not set up to do individual case work to resolve particular cases. For such individual case assistance, please contact your local State Health Insurance Assistance Program (SHIP) for help. California’s SHIP, the Health Insurance Counseling & Advocacy Program (HICAP), can be reached at 1-800-434-0222.
