The Med Diva

An insider's guide to Medicare Part D and more

Archive for the tag “SilverScript”

Caution: Stay away from Medicare Part D plans that have received sanctions from CMS

MH900349511This past week, I had to create a letter regarding a Medicare Part D plan that has been sanctioned by the Centers for Medicare & Medicaid Services (CMS) for conduct that “poses a serious threat to the health and safety of Medicare beneficiaries.”

Government sanctions, or penalties, are just one more reason it is critical for you to review your Part D options every year. If you are in a plan that has received sanctions from CMS, you definitely want to look for a plan that has a high star rating (3 ½ stars or better) to make sure you are going to receive the services you pay for and deserve.

SmartD Rx, a new Part D plan from the Smart Insurance Company, is one plan that is not currently accepting enrollments due to CMS sanction action (I guess the company is not so smart). Here is just part of the letter from CMS to Smart Insurance Company regarding its SmartD Rx plan:

The Centers for Medicare & Medicaid Services (CMS) hereby informs Smart Insurance Company (Smart) of its determination to immediately impose intermediate sanctions…

These intermediate sanctions will consist of the suspension of the enrollment of Medicare beneficiaries…and the suspension of all marketing activities to Medicare beneficiaries. CMS is imposing these intermediate sanctions immediately, effective April 23, 2013…because it has determined that Smart’s conduct poses a serious threat to the health and safety of Medicare beneficiaries.

In its short tenure as a Part D sponsor, Smart has experienced widespread failures in numerous important operational areas including:

• Smart inappropriately rejected drug claims at the point of sale (i.e., pharmacy counter);

• Smart failed to properly process coverage determinations (i.e., requests for drug coverage or payment and reimbursement);

• Smart denied enrollees the chance to appeal rejected claims and failed to ensure that denied coverage determinations were reviewed by an independent third party; and

• Smart failed to process enrollment and disenrollment requests, or failed to properly process enrollment transactions.

As a result of Smart’s noncompliance, its enrollees have experienced delays or denials in receiving prescription drug coverage and increased out-of-pocket costs.

CVS Caremark’s SilverScript is another Part D plan that received sanctions from CMS in 2013. In its letter to the SilverScript Insurance Company—a subsidiary of CVS Caremark – CMS wrote:

Since January 1, 2013, SSIC has experienced widespread data system failures that have directly led to extensive violations of the Part D program’s requirements regarding enrollment processing, call center operation, and claims processing. These failures have created disruptions in tens of thousands of Medicare beneficiaries’ access to prescription medications.

 From January 1 through January 14, 2013, CMS received 2,340 complaints about SSIC’s Part D operations. CMS has received complaints about SSIC at a rate four times greater than the rate of complaints received about all other Part D sponsors combined during the same period.

Other Medicare plan sponsors that have been sanctioned by CMS in the past include HealthNet,  Arcadian, and Universal American (all 2010), and Universal Health Care Insurance Company (2013). You can go to the Part C and Part D Enforcement Actions page on the CMS website for a complete list of plans that have received sanctions and other enforcement actions or had sanctions lifted.

How to get out of a bad Medicare plan

If you are enrolled in a plan that has been sanctioned, and you have personally been affected by your plan’s poor performance, you may be able to get out and switch plans outside of the Open Enrollment period. Your chance to switch is determined by CMS on a case-by-case basis, so you’ll need to call Medicare at 1 800 MEDICARE (1 800 633-4227), 24 hours a day, 7 days a week. TTY: 1 877 486-2048. Or go to this page at Medicare.gov for more information.

Don’t Settle for Lousy Customer Service in Your Medicare Plan.

Don't settle for a bad Medicare plan

Don’t get stuck in a jam if you don’t like your Medicare plan.

I recently came across a slew of complaints about the SilverScript Medicare Part D plan on the Complaints List website. (SilverScript is sponsored by the SilverScript Insurance Company, which is an affiliate of CVS Caremark.) The majority of complaints were about the drug plan’s customer service – or alleged lack thereof.

For example, Rita posted this complaint:

I’ve been treated rudely, after waiting on hold for an hour plus, sent to someone else after another 45 minutes, then that person said to hold and hung up on me. There should be a law about these customer service people treating the disabled elderly with more respect. Their day will come too. I feel as if they don’t care if we live or die and if we die without our meds they would be happy.

Now, I need to point out that last month the Centers for Medicare and Medicaid Services took action against SilverScript for issues related to claims processing (for example, some claims for new members were being rejected at pharmacies). Many of the complaints on the Complaints List website may be tied to this claims processing issue; however, it appears that the SilverScript customer service reps have not been properly trained on how to help people and treat them with respect.

No one should have to deal with horrible customer service. That’s why Medicare has established a 5-star special enrollment period.

Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. As I’ve mentioned before, low star ratings typically mean lower quality and poor customer service.

Last year SilverScript earned only 3 stars from Medicare. This was the lowest star rating among the top 10 Medicare Part D plans in 2012. Based on all the complaints I’ve read, it won’t surprise me if the plan’s ratings drop even lower for 2013.

Here’s the good news for Rita and everyone else who has complaints about his or her Medicare plan: You may not have to settle for a plan with bad customer service all year long. That’s because you can switch to a 5-star Medicare Prescription Drug Plan or Medicare Advantage Plan if you are not happy with your current plan. The Special Enrollment Period for joining a 5-star plan runs from December 8 through November 30 every year.

Although very few plans have earned a 5-star rating from CMS this year, if you’re fortunate enough to find one that serves your area, you can disenroll from your current plan if you’re not satisfied and join a plan that has earned 5 stars.

Use the following resources to get plan ratings:
• The overall plan star ratings are available at the Medicare Plan Finder.
• You can call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
• You can download the Medicare fact sheet, which has additional information about star ratings.

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