Back-Billing Problems Solved for 18,000+ Beneficiaries in Secure Horizons Plans

Back-Billing Problems Solved for 18,000+ Beneficiaries in Secure Horizons Plans

Beneficiaries enrolled in AARP Medicare Complete, a Medicare Advantage HMO sponsored by Secure Horizon have reported being back-billed for past months and/or years of premiums they did not know they owed. This has caused some panic and much distress for beneficiaries receiving bills for hundreds, sometimes thousands of dollars of premiums and no extra money with which to pay. California Health Advocates alerted the Centers for Medicare and Medicaid (CMS) about the problem, and CMS and United (Secure Horizons’ parent company) have recently come to a resolution. Below is a summary of the 2 kinds of back-billing problems, United’s actions and terms of resolution for each kind of problem, and a discussion regarding some of our ongoing concerns.

Two Kinds of Back Billing Problems

The 2 kinds of back-billing problems had to do with enrollees with dental benefits, and enrollees dually eligible for both Medicare and Medi-Cal.

Dental benefits – Some Secure Horizons enrollees signed up to receive an optional dental benefit and to have their premiums deducted from their Social Security checks.  Yet, as it turns out, Secure Horizons was not set up to deduct the additional dental benefit premiums from their Social Security checks, and therefore none of their premiums were paid. Secure Horizons did not bill members for the dental premium until recently, back-billing for several months’ or years’ premium. United (Secure Horizons’ parent company) agreed to write off the premiums for the months when members were not billed.  These cases were closed a few weeks ago.

Beneficiaries on Medicare and Medi-Cal – Many of these cases were first reported to us from the Health Insurance Counseling and Advocacy Program (HICAP), and CHA in turn inquired of CMS.  Some of the cases involved beneficiaries who were in a Secure Horizons plan even before 2006 when Medi-Cal paid the monthly premium.  These beneficiaries did not receive an invoice or coupon book until recently.  The invoices ranged from $990 to almost $3,000.

More than 18,000 beneficiaries were affected, yet it is still unclear whether all affected beneficiaries were in California. As United investigated the problem, they found that members fell into 4 categories depending on different dates, and United’s action was tailored accordingly.  Common to all cases, United agreed to write off balances during periods when United failed to bill or billed incorrect amounts.  However, for periods when United billed correctly, United expects to collect these amounts going forward.  If members cannot pay several months’ premium (for periods when United billed correctly and in a timely manner), United will offer payment plans.

For all categories, United developed appropriate communications to members, which were submitted for CMS approval and were sent to affected members in late November. According to CMS, they have also re-trained their staff to properly address this issue.  If United members have complaints related to this back-billing problem, they should call the plan and also 1-800-Medicare to log the complaint.

Additional Issues of Concern

Some issues we continue to be concerned about include:

1.     For some beneficiaries, when they called Secure Horizons about the lump sum invoice, the plan representative negotiated and reduced the amount due.  If a beneficiary paid the reduced amount, he or she should get a refund (or credit) if what he/she paid was for a period that United has agreed to write off. We are concerned about if, how and when they will receive this refund and whether CMS is monitoring this process.

2.     Beneficiaries with Medicare and Medi-Cal (also known as “dual eligibles”) may not know that they have a Special Election Period (SEP) to disenroll from their Secure Horizons plan.  We communicated our concern to CMS and they responded that they would ask United inform these beneficiaries of their SEP rights.

3.     Some dual eligibles were enrolled in their Secure Horizons plan before 2006, when Medi-Cal paid the premium.  When the policy changed and Medi-Cal no longer paid the premium, these beneficiaries may not have been notified that they would now be responsible for their MA plan premium.

4.     A related issue is dually eligible beneficiaries who were told by sales reps that they would not have to pay a premium because they have Medi-Cal.  As mentioned above, Medi-Cal does not pay the premium of Medicare Advantage plans for beneficiaries who are dually eligible for Medicare and Medi-Cal.  If a beneficiary cannot afford  the premium, they can disenroll or change to a plan with a lower premium.  They have an SEP to disenroll or change plans.

If you hear of any additional cases regarding this back-billing issue, please contact your local HICAP at 1-800-434-0222.

See Special Election Periods for Parts C and D for more information on SEPs.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.