It’s not everyday that the Centers for Medicare and Medicaid Services (CMS) cracks down hard on one of its clients; that is, one of the private insurance companies Congress allowed and encouraged to provide benefits to Medicare recipients. Bloomberg News published a story Monday that told a sorry tale of the country’s second largest insurance carrier (revenue-wise) and how it treated seniors who depend on coverage from the company to pay for their drugs. CMS gave Bloomberg a copy of the letter it sent to WellPoint which said the carrier has “demonstrated a longstanding and persistent failure to comply with CMS’ requirements for proper administration of its Medicare Advantage Prescription Drug Plans (MA-PD) and Prescription Drug Plans (PDP).”
The letter went on to say that the noncompliance has resulted in thousands of Medicare beneficiaries being denied access to “critical medications” that included cardiac drugs, anti-seizure drugs, anti-clogging drugs as well as medicine for asthma and chronic obstructive pulmonary disease. “WellPoint failed to follow through on its assurances to CMS that the problem was immediately and fully corrected,” the letter explained. CMS spokesman Peter Ashkenaz told me that the Medicare regulator had gotten a spike in complaints from WellPoint customers last week when new drug plans took effect. In December, he said, the agency received “under 100 complaints” and in the first week in January “we had more than 500. People were not getting their drugs.”
So the agency slapped a penalty on the carrier: effective immediately, it cannot market Medicare Part D plans, which provide pharmaceutical benefits to seniors, nor can it enroll new plan members. Even though the general Part D open enrollment season just ended, carriers can still sign up seniors with low incomes and people turning 65 who need to find a drug plan. Seniors enrolled in the controversial Medicare Advantage plans whose sellers are being overpaid by the federal government, can still switch plans until the end of March. So it’s fair to say the sanctions are likely to pinch WellPoint’s profits. WellPoint said in a statement that it had made significant progress in addressing problems cited by CMS and that since it had been working with the agency, it was “surprised by this recent action.”
Not many reporters cover insurance these days. But this is a good story, as Bloomberg knows, and a good company to keep an eye on. There are several ways to go. There are the usual business stories that quote stock analysts lamenting a fall in the company’s share price. The Bloomberg story went there. Carl McDonald, an analyst at Oppenheimer & Co., told Bloomberg that the CMS sanctions are “definitely not a good thing.” Then there’s the consumer story which tells people what to do. Bloomberg pointed out that people can stay with the carrier, or if they choose to drop out, they can call 1-800-Medicare and ask about a special enrollment period to select a new plan by the end of the month. Much less transparent to journalists is the health reform story and where WellPoint fits in. The insurer is a lobbying force. It helped to defeat Gov. Arnold Schwarzeneggar’s health reform drive in California in 2007 with a series of TV ads raising doubts about the plan, and it was prepared to spend millions to keep reform from happening. WellPoint has staked out a lucrative market selling bare bones policies, the kind that many politicians see as the solution for covering everyone. It could benefit handsomely from many of the reform proposals now on the table if they require people to buy health coverage from private insurers.
In case you think WellPoint is alone in designing questionable insurance practices, take note. Yesterday the nation’s biggest carrier UnitedHealth Group agreed to pay a $50 million settlement after New York attorney general Andrew Cuomo accused the insurers of overcharging millions of customers when a research firm owned by United manipulated the numbers so that the carrier underpaid policyholders when they filed claims. Said Cuomo: “This is a huge scam that affected hundreds of millions of Americans who were ripped off by their health insurance companies.”
All this should prompt reporters to investigate whether these kinds of insurance shenanigans are what Americans prefer when they say they want universal coverage. For example, what will prevent WellPoint from continuing the same practices for policyholders under 65 that CMS has said it engaged in for seniors on Medicare? What will stop insurers from paying as little as possible and shoving more costs of medical care onto unsuspecting policyholders? And while they’re at it, a hard look at whether regulation can really discourage such practices is in order. Remember, the president-elect said during the campaign that he would tightly regulate health insurance. The case of WellPoint and UnitedHealth Group invites scrutiny of this campaign promise.




As a Broker with 30+ years of experience in the industry it is NO SURPRISE that the AARP's United Health Care has been sanctioned by New York state. I enrolled my mother with their Secure Horizons Plan and they continually lied that her claims had been paid. She even had her account turned over to a Debt Collector. Finally after threatening legal action and exposure to the Press her bills were paid.
Posted by ART DeANGELIS on Thu 15 Jan 2009 at 04:03 AM
This comes as no surprise to me, after experiencing what they did to me in December of 2007, after they bought the insurance company I did business with.
What does come as a surprise to me is that no one is investigating this company. There has to be some type of regulations put on Health Care Providers, that stops monopolies like WellPoint from deciding who gets healthcare and who does not, and rigging their business plan for profit only, at the COST of consumer's health, and healthcare.
Following is a post I did on ripoffreport.com, on August 1, 2008. My comment is in reference to consumers who are complaining that the mail-order pharmacy, NextRX (WellPoint) is ripping them off.
Google Wellpoint...
They are not simply a mail-order pharmacy, but a huge corporation going across the country and gobbling up Health Insurance companies. That is how I got introduced to them. They obviously STUDY their client lists through the insurance companies they buy. That is how they knew how to deliberately con me.
They did the exact same thing to me, but in a more deceptive manner. They absolutely refused to cancel the order. (First order with them was $140.00...great price for 3 months, second order was $467.00!!! Aghhhhhh!!! I could not afford that, and did not need 3 months at a time. Absolutely no savings!
I was talked terrible to, even threatened!!! I was told by a supervisor, that I WOULD accept the shipment and TAKE MY MEDICINE....OR refuse my medicine and I would not only be without my medication for 3 months, BUT, also without my money, as they had charged my credit card. I hung up, almost in tears as to what to do, then thought to call my credit card company.
My credit card company put me in touch with their legal claims department and took notes as to what exactly happened, kind of like a deposition, and told me to go ahead and refuse/return by signature upon receipt, the medication when it arrived. The credit card company handled all the investigation. Wellpoint REFUSED to credit the money back to my account, but after a 2 month investigative procedure by credit card company, they TOOK the money from Wellpoint's accout and credited it back to my account.
Well, this really made Wellpoint mad, they told me I HAD TO ACCEPT THEIR DRUGS AND THEY SENT THEM BACK TO ME!!! They told me I had to accept them as I might have poisoned them! (This actually scared me, as I figured they were so mad at me, that perhaps they tampered with them??? Who is to say?)
Credit card company told me at this point I could go ahead and keep the drugs, however, since I had my money back, I returned them, again!
By the way, Wellpoint kept their word, and when I went to buy 1 month supply at my local drugstore, I could not because Wellpoint left it on records that I already had a 90 day supply, so for 90 days, I went without heart, kidney and allergy medications.
Wellpoint was not done yet, they continued to harass me every month since last December, 2007, when this transaction occurred, sending me NOTICES that the $467.00 was due AND to be paid immediately.
Figuring they would take me to collection agency and ruin my credit, I did some basic research on Pharmacy Law regarding Indiana, where I live. Specifically, mail-order pharmacy law. A Mail Order Pharmacy MUST obey the STATE that they transport drugs into or across the borders of. Wellpoint says they do not. Wellpoint says they only have to obey Texas State Law. I was told this by several supervisors I talked to. Each time, I held my ground, and told them they must obey Indiana State Law when they cross the border. Bottom line is Indiana State Law says all mail order drugs CAN be returned except for controlled substances and diabetic supplies. A Pharmacist only needs to give the okay. Needless to say, Wellpoint would not let me speak with a Pharmacist.
At this point I am ready to take case to a lawyer, but wanting this to go away as I am tired of the stress, I called my Insurance company, AGAIN, and this time told them that if Wellpoint did not stop harassing me, or tried to ruin my credit, I would seek legal help in the matter. Here, take note of all the lawsuits against Wellpoint when you google them.
Well, July, 2008 is the first month I have not heard from them, so I need to follow up with my Insurance company as to what happened, as my Insurance company has not copied me on any of the legal process to stop this, as they had said they would ,since this was an official complaint. I am just so worn out over all this mess. Oh yeah, did I mention Wellpoint bought my Insurance company? It used to be a good Insurance company, now I noticed their name,too, on this site, and they are screwing everyone left and right, and yes, me too, but that's another story.
To make matters worse, like rubbing salt in a wound, my local newspaper did a Front Page, brag section on the top wage earner to head a publically traded company in Indiana for the year 2007. And, who might that be? Angela Braly of Wellpoint got a 2.3% raise over her wages in 2006. For 2007, she made $14,855,460.00! YES, you read that right! Almost 15 million dollars for 1 year, and they are destroying my health fighting over 467.00
It is a real pity to pay this sum of money to someone who knows the company resorts to this manipulation of consumers. The people I dealt with at Wellpoint were like trained robots, all saying the same thing, and being quite heavy handed with the subtle and not so subtle threats.
TWICE, I was told when I tried to talk with customer service people about my situation and what had happened, I was told I had the wrong department. They were actually very nice people and transferred me to the CORRECT department for my complaint. Who do you supposed answered the phone BOTH of those times....voices that said, SENIOR SERVICES DIVISION. I was horrified with the implications the second time it happened to me. I am not a senior citizen, but this tells me that this is a scam they are pulling on the elderly. Imagine yelling at an elderly person, I HAVE YOUR MONEY, SO TAKE YOUR HEART, KIDNEY AND ALLERGY MEDICINE, OR YOU WILL NOT ONLY LOSE YOUR MONEY, BUT YOUR MEDICINE FOR 90 DAYS! The thought of this sickens me.
WellPoint should change their name to SickCircle, as that is what they are really in business for, not a healing business at all.
Finally, my advice, avoid talk with Wellpoint. It is a total waste of time. Talk to your credit card company, perhaps your Insurance company, BEWARE, Wellpoint may own them, AND your State Attorney General. Good luck, and stay well!
So, as you can see from my post on that site, I had already surmized they were preying on the elderly. Wow...was I right...
And, by the way, I still have never heard from them again, or from my Insurance company as to what happened to my complaint.
One other major concern is the future of electronic medical records. I do see the many pros of the idea, but after experiencing the above situation, that is exactly what WellPoint does, after it buys Insurance companies, it goes right into the medical records and devises ways to make money. This is anything from deciding what to cover, what not to cover, having consumers buy their pharmaceuticals with the lie that these mail-order drugs will save consumer lots of money, etc.
Knowing the crooks they are, I imagine many of the recent people they are letting go, are people who know too much about their management styles. They are using the 'jobcuts' of the economy as an excuse. (Hmmm, do I sound prejudice?)
Posted by Maya on Fri 16 Jan 2009 at 06:42 PM
Senator Evan Bayh's wife Susan Bayh sits on the WellPoint Board. She received $317,000 in 2008 or '07'. Now Sen. Bayh tells us he isn't compromized becaused he and wife don't discuss the issue. Yeah, sure.
Posted by Katherine Elsea on Sun 28 Jun 2009 at 11:49 AM