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Life Health > Health Insurance > Medicare Planning

GAO Pans Drug Plan Call Centers

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Officials at the U.S. Government Accountability Office and the Centers for Medicaid & Medicare Services are clashing over the best way to evaluate Medicare Part D customer service.

The GAO has published a report that has concluded that Medicare Part D drug plan call centers are usually quick and polite but may not provide complete, accurate answers to consumer questions.

GAO officials say they developed their list of 5 test questions by reviewing the “frequently asked questions” section on the CMS Medicare Part D Web site and asking CMS officials and consumer advocates about what consumers needed to know about the Part D program.

These were the questions:

1. “My mother takes the following drugs: Norvasc, Fosamax, and warfarin sodium. Which of the sponsor’s plans would cost her the least amount annually and what is its annual cost?”

2. “My mother-in-law takes the following drugs: Aciphex, Benicar, Evista, Levoxyl, Pravachol, Synthroid, Zetia, and Zoloft. Which of the sponsor’s plans would cost her the least amount annually and what is its annual cost?”

3. “My mother automatically qualifies for extra help because Medicaid pays part of her Medicare premiums. Does the sponsor offer a plan that she can join without having to pay a premium?”

4. “If some of my grandfather’s drugs are not covered, will he have to pay full price for them, or are there other things he can do?”

5. “If some of my grandfather’s drugs are covered, but subject to restrictions, what does that mean?”

Reps at customer service centers called in March answered 96 of the calls within 5 minutes, and 98% of the reps who answered were polite, professional and easy to understand, Leslie Aronovitz, a GAO official, writes in a letter describing the results of the study, which was conducted at the request of Democratic members of Congress.

But the reps had no answers for the test questions 15% of the time and gave what the GAO believes to be inaccurate information 22% of the time, Aronovitz writes.

CMS Administrator Dr. Mark McClellan has countered with an article contending that the GAO questions bear little resemblance to the questions consumers really ask, that drug plan call centers were not required to be able to answer the first and second questions on the GAO list, and that, in some cases, the GAO testers seemed to be asking customer reps to violate program rules by “steering” callers to specific plans.

Aronovitz says the GAO developed its questions by using consumer information on the CMS’ own Web site.

Although drug plan call centers were not required to be able to answer all of the questions the GAO testers asked, “agency officials had indicated that the information we sought from [customer service reps] was within the scope of plan sponsor customer service efforts,” Aronovitz writes. “In addition, as noted in the draft report, some call centers were relatively successful in providing accurate and complete answers to questions 1 and 2, indicating that call center CSRs can handle such questions appropriately.”

The GAO also believes that customer service reps can use objective information to guide consumers without violating CMS rules against steering consumers to drug plans for financial gain, Aronovitz writes.

America’s Health Insurance Plans, Washington, put out a statement echoing CMS criticisms of the GAO report.

“The GAO analysis of call centers scored Medicare Part D plans on their ability to discuss some information that customer service representatives are expressly forbidden from providing under regulations governing the program and responses to vague and misleading questions that are not representative of questions posed by real beneficiaries,” AHIP President Karen Ignagni says in the statement.

AHIP put out its own list of typical Medicare Part D call center questions:

1. “I recently enrolled, what is the status of my application?”

2. “My doctor prescribed a new medication, is it on the formulary?”

3. “I receive the Low Income Subsidy, what are my co-payment amounts?”

4. “When will my Social Security premium deduction be taken from my check?”

5. “Will I receive a plastic ID card? When will I receive it?”

A copy of the GAO report is on the Web at Document Link


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