The open registration of medical insurance is the open season for scammers

The open registration of medical insurance is the open season for scammers



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I’ve come and I hate being so heavy on the public enrollment of medical insurance. But some readers thanked us for making this topic a priority and said it helped them make better decisions about health insurance options.

If you are lucky not to be exposed directly or indirectly, the open season for the elderly will last until December 7. For those who have to deal with Obamacare options, you haven’t seen much.

Although my anecdote is far from perfect, this year seems to be certain that the Medicare Advantage plan hawkers spend more time on air time than the previous two years. At that time, I unfortunately took a break while watching TV in my room during commercials. Not only is the shilling as bad as Thighmasters, the weight loss program, and the ambulance chasing the law firm, but these promotions are completely dishonest. Even the scary and almost as frequent drug advertisements, at least allowing the narrator to recite quickly, is usually a side effect of the horror performance level. Here, there is obviously no requirement for full disclosure. For example, Medicare Advantage shills often talk about prescriptions being “covered.” When anyone who has recently enrolled in health insurance knows if they are taking any expensive drugs, they need to check whether their drugs are covered, because there is a high probability that they will not .

This article discusses another type of abuse: phone representatives lie to consumers or even include them in the plan without their consent. These practices have become so common that CMS now allows Medicare participants to withdraw from the distorted plan.

Oh, and one of the TV commercials described as deceptive in this article sounds like an ongoing promotion here. And pay attention to how scammers deceive medical insurance and local hospital numbers as their caller ID. guard against!

Author: Susan Jaffe originally published on Caesars Health News

Finding the best private medical insurance drugs or medical insurance plans among dozens of options is difficult enough without introducing misleading sales strategies.

However, federal officials say that more and more seniors are complaining that purchase policies—without their consent or being lured by suspicious information—may not include their drugs or include their doctors. In response, the Centers for Medicare and Medicaid Services threatened to penalize consumers if private insurance companies that sell Medicare advantages and drug plans or agents who work on their behalf mislead consumers.

The agency has also amended the rules to make it easier for beneficiaries to evade plans for which they are not registered or registered, only to find that the promised benefits do not exist or they cannot see their providers.

These problems are especially common during Medicare’s open registration period starting on October 15th and lasting until December 7th. A common trap started with a phone call, such as that received by Linda Heimer, a resident of Iowa, in October. She will not answer the call unless her caller ID shows a number she recognizes, but this time the call shows the number of the hospital where her doctor works.

The person who answered the phone said that she needed Heimer’s Medicare number to make sure that the new card she received was correct. When Haimer hesitated, the lady said, “We don’t want a social security number or a bank number or something like that. It’s okay.”

“I couldn’t believe it, but I gave her my card number,” Haimer said. Then the caller asked about her medical history and offered to give her a saliva test “completely free”. At this moment, Haimer began to doubt and hung up. She contacted the 1-800-MEDICARE helpline to obtain a new Medicare number, and called the AARP Fraud Watch Network helpline and the Federal Trade Commission.

But later that morning, the phone rang again, and this time the number displayed on the caller ID matched the free medical insurance hotline. When she answered, she recognized the same woman’s voice.

“You are not from medical insurance,” Haimer told her.

“Yes, yes, yes, we are,” the woman insisted. Haimer hung up again.

It has only been two weeks since Heimer revealed her health insurance number to strangers, so far nothing has gone wrong. But with this number, scammers can charge medical insurance for services and medical supplies that beneficiaries have never received, and scammers can register medical insurance benefits or drug plans for seniors without their knowledge.

The organization’s case manager, Sandy Morales, said that in California, reports of fraudulent sales of Medicare Advantage and drug plans were the highest reported to the state’s senior medical insurance patrol in the past two years. complaint. Patrol is a federally funded program designed to help seniors solve insurance problems.

Rebecca Kinney, Director of the Office of the Community Life Administration, said that across the country, in the first nine months of this year, the senior medical patrol sent more cases to CMS and the Inspector General of Health and Human Services than in 2020. 74% more. HHS’s health care information and consulting department is responsible for overseeing patrols. She expects to receive more complaints while Medicare is open for registration.

Last month, CMS officials warned private insurance companies selling Medicare Advantage and drug plans that the federal government would prohibit fraudulent sales.

Kathryn Coleman, director of CMS’s Medicare drug and health plan contract management team, said in a memo to the insurance company that the agency is concerned about advertising widely promoting Advantage plan benefits, which are only available in a limited area or a limited number of beneficiaries. She pointed out that CMS has also received complaints about sales information, which may be interpreted as coming from the government and pressure tactics to force seniors to enroll.

Coleman reminded these companies that they are “responsible for their marketing materials and activities, including the marketing planned by the sales representative on behalf of the MA.” Companies that violate federal marketing rules may be fined and/or face suspension of registration. However, a CMS spokesperson could not provide examples of recent violations or penalties for them.

If the beneficiary discovers the problem before March 31 of each year (the end of the three-month withdrawal period), they have the opportunity to switch to another plan or the original Medicare. (Those who choose the latter may not be able to purchase supplement or Medigap insurance, with very few exceptions, All states except four states: Connecticut, Maine, Massachusetts and New York. ) After March, they are usually locked in their advantage or drug plan throughout the year, unless they qualify for one of the rare exceptions to the rule.

This year’s CMS Clarified another remedy first.

For those who want to withdraw from the program due to deceptive sales strategies, officials can grant a “special registration period.” These include “the beneficiary’s oral or written allegations claiming that his or her participation in the MA or Part D program was based on misleading or incorrect information… [or] The beneficiary declares that he or she joined a plan without his or her knowledge,” according to the Medicare Management Care Manual.

David Lipschutz, deputy director of the Medicare Advocacy Center, said: “This is a very important safety valve for the beneficiaries, obviously not just a limited opportunity to change the plan when someone feels the buyer regrets it.” To use the new Option, beneficiaries should contact their state’s health insurance assistance program:

If a large number of plan members cannot visit a doctor or hospital that should be in the provider’s network, they can also choose to leave.

Experts say that despite this, scams continue across the country.

Morales said that a misleading TV ad in the San Francisco area attracted senior citizens with a series of new benefits, including dental, vision, transportation benefits, and even “money returned to your social security account.” She said that the beneficiaries told her group that when they asked for information, they “wrongly joined a program they never allowed to join.”

In August, a senior in Ohio received a call from someone telling him that due to the COVID-19 pandemic, Medicare is issuing a new card. Ohio Senior Health Insurance Information Program Director Chris Rigg said that when he did not provide his health insurance number, the caller became angry and the beneficiary felt threatened.

Reeg said that another elderly person received a call from a salesperson and told her the bad news: She did not get all the benefits from the Medicare she deserved. The beneficiary provided her Medicare number and other information, but did not realize that the caller was enrolling her in the Medicare Advantage plan. She discovered when she went to see the doctor that the doctor did not accept her new insurance.

In western New York, the culprit was an official postcard, said Beth Nelson, director of the state’s senior health insurance patrol. “Our records indicate… you may be eligible for additional benefits,” it said seductively. When Nelson’s customer called the number on the card for more details in September, she provided her Medicare number and later joined the Medicare Advantage plan without her consent.

Heimer’s liar is stubborn. Heimer said that when the stranger tried to contact her for the third time, the caller ID showed the phone number of another local hospital. She told the lady that she had reported these calls to CMS, AARP Fraud Watch Network hotline and FTC. It finally succeeded—the woman suddenly hung up.


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