Tag: prescription drugs

The companies are suspended from enrolling new customers and marketing to Medicare beneficiaries.

If you have United American or First United American Life, your plan will remain the same, and is not affected by this suspension.
You do not need to change your plan.

United American’s Part D homepage, which says that they are not taking new enrollees. It reads, “Thank you for your interest in our Medicare Prescription Drug Plans. We are not able to take enrollments into our plans at this time.”

United American Insurance Company and First United American Life Insurance Company have the highest rates of complaints in the Medicare Part D program, and had been dealing with those complaints, and other aspects of customer service, inappropriately.

In a letter to the CEO of Torchmark Corporation, which owns United American and First United Life, a Medicare official says the sanctions will start on August 1, 2015. They will continue indefinitely, until the Centers for Medicare & Medicaid Services are convinced that the company’s’ failures have been addressed and corrected, and will be prevented in the future.

Medicare began investigating Torchmark in 2012, when they found multiple violations regarding coverage determinations for Part D, as well as the handling of customers’ appeals and grievances. Torchmark was fined $150,000 in April 2013 for these violations. In a follow-up investigation, Medicare found that Torchmark had not corrected the violations from 2012, and in September 2014, fined them $40,000. Medicare called the problems “widespread and systemic” failures, which had remained uncorrected for over two years.

In the letter, Medicare listed 8 total violations, including:

• Failing to fully address grievances, and failing to resolve grievances within Medicare’s time guidelines, or as cases required.
• Wrongly categorizing coverage determinations as re-determinations, and mislabeling both as grievances or customer services questions.
• Neglecting to forward coverage determinations to the Independent Review Entity in a timely manner.
• Causing improper denials of payment under Part D by neglecting to perform Part B vs. Part D determinations for transplant medications.
• Failing to include specific information about why an enrollee was denied coverage.
• Neglecting to enforce changes recommended by the Independent Review Entity to fix previous violations.

These resulted in unnecessary delays or denials of prescription drugs, financial hardship for customers, lapses in coverage and other consequences, like sending bills to the wrong customers.

Tom says:
Medicare is keeping close tabs on companies that don’t listen to their customers. This is a line you don’t want to cross as a Medicare insurance company. They have sanctioned many companies in the past for this very same issue (see the links below on sanctioned companies). It is good to know that the government has it’s eye on the behavior of Medicare insurance companies.

Read the letter that Medicare sent to Torchmark here.

Medicare has issued sanctions in the past to companies who were negligent. See these links (here, here and here)
for more background information.