May
5
HMO sales deceiving, seniors say
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Originally published in The Palm Beach Post on Saturday, May 5, 2007.
By KATHLEEN CHAPMAN
Palm Beach Post Staff Writer
WEST PALM BEACH – Angela Cuba was at her doctor’s office for a swollen leg that hurt from hip to toe when she found out that Medicare would not pay for her visit.
The doctor whom she had visited for seven years wouldn’t see her that day because he did not take her new insurance plan. When the office explained the reason for her denial, Cuba, 80, said she was surprised to learn she had unwittingly signed papers agreeing to switch to a health maintenance organization.
Cuba is one of several seniors in the Southridge public housing neighborhood near Lake Avenue and Southern Boulevard who say strangers knocked on their doors with misleading sales pitches. Many were upset when they found out they had signed up for a new plan and no longer could visit their usual doctors.
For some, the switch led to months of confusion and frustration as they tried to get doctor appointments or prescription drugs.
Pam Wiener, elder care and crisis manager for the West Palm Beach Housing Authority, has made a series of formal complaints about what she believes are aggressive and deceptive sales practices by HMOs.
Wiener said 11 seniors in the neighborhood were persuaded to sign paperwork by sales representatives for several HMOs without realizing it would transfer them out of the traditional Medicare plans they preferred.
Two of the 11, who are not being named, have dementia, Wiener said. One man who was persuaded to join an HMO said in a recent mental evaluation that he thinks the year is 1977, she said. A third senior not being named has schizophrenia.
Cuba said she first thought the woman who came to her door worked for her doctor’s office, then was left with the impression that she worked for Medicare. Cuba said she did not realize that she had signed forms switching to an HMO until her doctor’s office explained it.
Marta Alvarez, her next-door neighbor, said a salesman told her to sign on the line if she wanted to save money on co-pays and receive her mailings in Spanish. She thought she was signing up for a special program within Medicare and said she did not realize that she would be in an HMO or no longer be able to see the same doctor.
And Rosa Saavedra signed an application printed in English, though she speaks only Spanish.
Both Cuba and Alvarez say the sales representatives who came to their homes were uninvited strangers.
Federal marketing guidelines do not allow agents for Medicare HMOs to solicit door to door or arrive at a senior’s home unannounced. Representatives are allowed to make phone calls pitching the plans but cannot enroll someone on the cold call and must make an appointment if they want to visit someone.
Lee Millman, a spokeswoman for the Centers for Medicare and Medicaid Services, said she could not comment on specific complaints. Violations of federal marketing guidelines are taken seriously, she said, and can lead to audits, fines, freezing a plan’s enrollment or in extreme cases terminating a plan, Millman said.
Executives at Suncoast Physicians Health Plan, the licensed HMO that enrolled Cuba, Alvarez and Saavedra, defended the company’s sales practices, saying its appointments are too thorough to leave any confusion about the plan. Ken Feldman, Suncoast’s executive vice president and chief financial officer, said those meetings average 45 minutes.
Feldman provided applications signed by the three women that say Suncoast Physicians Health Plan in large letters across the top. Seniors are given the name of the doctor whom they will see under the plan, Feldman said, and all information is reviewed once more in a follow-up phone call.
“We do things the right way, so as to always be in compliance with state and federal regulations,” Feldman said.
The insurance agent who went to the neighborhood has been licensed for 20 years, Feldman said. He said he has no record of any female agent enrolling people there, though Cuba said she was visited by a woman.
Feldman said it seems unlikely that the women would invite an insurance agent inside the house and share their Social Security and Medicare numbers if they did not understand what they were signing. You wouldn’t give your private information to a total stranger today, he said.
“How did they get in the house? How did they get all the information? How did they get them to sign the application? That’s just far too detailed and comprehensive,” Feldman said.
Marta Alvarez said the salesman talked his way into her house by chatting with her husband, who was working in the yard. She didn’t want to open the door, but she said the salesman told her that her husband had sent him. Alvarez said she thought the man and her husband had already had a conversation about health benefits.
The salesman said he was visiting people with Medicaid and Medicare, Alvarez said. He said people who were approved for a special program would not have to make a co-payment on their medicines.
She thought he worked for a traditional Medicare plan.
He asked her if she wanted her approval letter to come in English or Spanish. If you want it in Spanish, he told her, sign here. Alvarez signed.
She said she later found out he had not spoken at any length with her husband. She also said she did not understand that he represented an HMO or that joining would limit her to a certain group of doctors.
She said she threw out a mailing from Suncoast that explained the plan, thinking it was an unwanted solicitation. And anyway, she said through a translator, the materials were in English.
The Suncoast agent said he did have appointments to visit the women. Cuba and Alvarez signed Spanish-language forms. In Saavedra’s case, the salesman said he was out of Spanish-language forms but translated for her line by line. He provided marketing documents in Spanish, the agent said, and told her that if she didn’t understand the application, he could come back with a Spanish version.
But the housing authority’s Wiener doubts that all of the salespeople who came to the neighborhood had valid appointments. She said she confronted a man and a woman who were in the public housing development together and asked what they were doing. The name of the person whom the salesman said he was visiting did not match any on her resident list, she said.
Feldman questioned Wiener’s motives, saying the agent told him that she has a history of dissuading people from joining HMO plans.
“We question why she would be taking it upon herself to become involved in choices that private citizens are making with regards to their health care,” he said.
The insurance agent had a right to be in the neighborhood, which is public property, Feldman said, and will return if he is invited for an appointment.
The Suncoast plan provides health care with no membership fee and is a good alternative for seniors, he said.
Wiener said she has no problem with helping enroll residents who prefer HMOs. About a fifth of the residents are in HMOs, mostly Humana, she said. One of her newsletters this spring advertised free gym memberships for seniors in certain HMOs.
But many residents are attached to a particular doctor in Century Village who does not accept Suncoast, Wiener said. He has a Spanish-speaking assistant whom many residents like and is one of very few local doctors who will send a shuttle to pick up patients, she said.
Wiener said she has helped those who wanted to switch back to traditional Medicare.
A spokesman for CarePlus Health Plans, the HMO that enrolled the man who Wiener said has severe dementia, said it investigated the incident after receiving her complaint. The salesman, Tibor Sternberg, set up an appointment with the man after a telemarketing lead, in compliance with guidelines, CarePlus spokesman Mitch Lubitz said.
“CarePlus is satisfied that there was no misrepresentation or inappropriate activity on the behalf of Mr. Sternberg,” Lubitz said.
Salespeople go through ethical training and often work with family members when signing up new members, he said.
Millman, of the Centers for Medicare and Medicaid Services, said seniors who have a question about whether a plan is licensed, or want to make a complaint about marketing guidelines, should call (800) MEDICARE (633-4227).
Recently, Cuba said, she got a call from an HMO representative who was trying to see whether she may be interested in signing up.
No, she said, she was not.
Copyright 2007 The Palm Beach Newspapers, Inc.
Palm Beach Post (Florida)
May 5, 2007 Saturday
FINAL EDITION
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