So in the wee hours of the morning, while enjoying another spate of insomnia, I decided to kill some time looking up Wellcare, the Medicare Part D provider toward which I was leaning by the end of yesterday’s exploration of that corner of the insurance industry’s corporate bureaucracy.
I thought that exploration was through the Looking Glass? Ah, no, my friends: that was down the Rabbit Hole!
Turns out that in 2009 the federal Centers for Medicare and Medicaid Services enjoined Wellcare from enrolling new customers in its Medicare Advantage and Medicare Part D programs because of the egregiousness of the complaints against it. Says a Florida newspaper:
Regulators cited a long list of problems: deceptive sales practices, delays with urgent customer problems, forged enrollment documents and the highest complaint rate in the nation.
The “problems” have been going on for a while. In 2007, the FBI, HSS, and the Florida Attorney General’s office raided Wellpoint’s Tampa headquarters.
In a now-unsealed plea agreement [says Wikipdia], prosecutors and a former employee said the company inflated expenditures by submitting fake documents to the state. Under some mental health care contracts, WellCare was paid a flat per-patient fee and required to spend at least 80 percent of it on care. Any leftover amount beyond 20 percent was to be repaid to the state, but the bogus expenditures allowed WellCare to keep that surplus. WellCare agreed in August to repay $35 million, its best estimate of the total wrongly kept from 2002-2006. After the raid, the company restated its quarterly and annual profits, driving down net income by $32 million, and saw its top three executives resign. No criminal charges have been announced against WellCare or its officials but investigations by Florida, Connecticut and federal prosecutors are ongoing. The Securities and Exchange Commission is leading an informal investigation, and Wellcare faces numerous shareholder lawsuits and sealed whistleblower complaints, the company’s SEC filings say.
This is one of the best that Arizona offers?
Well, hell. I’m glad I looked the company up before I got myself into its Part D plan. But damn! this leaves me right back where I started before I spent several hours of my time trying to figure out which of these hideous outfits won’t rip me off or try to keep me from buying needed drugs.
There doesn’t seem to be anyplace you can go to get a straight story about these companies. The material at the Centers for Medicare and Medicaid Services website is highly technical—there’s nothing that seems helpful for consumers. The HealthMetrix Research site addresses Medicare Advantage programs, which don’t interest me. The National Senior Citizens Law Center (NSCLC) noted in October 2009 that Wellcare still appeared in the government’s listing of Part D providers even though it was still prohibited from enrolling new customers. Very few, if any, intelligible resources are out there.
The Center for Medicare Advocacy notes,
Medicare beneficiaries, their advocates and other helpers cannot be assured that the information provided to them on the Plan Finder is accurate. They need to drill as deeply as possible into the Plan Finder tool to ascertain whether reference-based pricing and other utilization management tools apply to their prescriptions. They need to check the plan web site and contact the plan customer service line to ascertain how the pricing might work. Even then, they cannot be assured that the plan they believe to be the lowest cost drug plan for them will, in fact, provide the most coverage at the lowest cost.
NSCLC advises people to talk to their State Health Insurance Assistance Program (SHIP). In Arizona this office is staffed by volunteers. I’ve had a couple of good experiences with those folks and one that was not so great. The last guy I got on the phone was an utter moron. He flat refused to listen to the question I was asking him and instead nattered on and interminably on with stuff that wasn’t relevant and that I already knew. Another one, a woman, was very nice and personally supportive, but when you came right down to it she just wanted to chat—what she told me wasn’t especially useful or enlightening. A third person gave me some very good information. But you see the issue: I had to call three times and talk to three different people to get a cogent answer to a simple question.
I can see I’m going to have to blow another day trying to figure this garbage out. Beyond annoying…beyond frustrating…it’s infuriating!