updated 7/2/2007 4:53:25 PM ET 2007-07-02T20:53:25

The health insurance salesman who came to Gloria Young’s house made a strong pitch. His company’s private Medicare plan could meet her needs just as well and much more cheaply.

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Like many other people, however, after she signed up she found her doctor wouldn’t accept the plan — and she faced months of hurdles switching back.

When Young, 61, of Victory Mills, N.Y., went to her doctor a month after switching to the new insurance, a sign at the front desk said the doctor did not accept the private plan she had just switched to.

The nurse then gave her even more alarming news. The new plan would not cover any of her medicine. Young would need to buy that insurance coverage separately.

When she got home, Young called the agent immediately to discuss what she had just seen and been told, and she let him know she needed to cancel before the insurance policy took effect Jan. 1.

“He all but called me a liar,” she said.

‘Tip of the iceberg’
Over the following months, Young was dogged in her efforts to not let her old insurance lapse and to not let the new insurance kick in. She called the company repeatedly. She mailed a premium check to her old plan. They returned it. She called lawmakers and scores of government agencies, she said.

The new policy kicked in anyway, and it would take another five months before she could switch back. Along the way, she missed physical therapy sessions and switched to cheaper, but less effective medications.

Bob O’Malley, a spokesman at Universal American Financial Corp., did not know the details of Young’s case. But he did say all beneficiaries are allowed to switch plans during an open enrollment season — the first three months of the year. If Young had enrolled in still another plan then, it would have replaced her American Progressive coverage.

“That’s why open enrollment is a three-month period, so people have an opportunity to change their minds,” he said.

Officials with an advocacy group that helped Young — the Medicare Rights Center — said she represents hundreds of seniors who have contacted them because they can’t get out of insurance bought as a result of misleading sales tactics.

“We see only the tip of the iceberg,” said Robert Hayes, the organization’s president.

The problem is that the government failed to establish an effective, seamless process for those who opt out of private plans called Medicare Advantage, Hayes said.

Regional Medicare offices around the country are the first point of contact for his agency, Hayes said.

“Each office plays by different rules in helping people. Literally, different people in the same office play by different rules,” Hayes said. “It can be weeks, it can be five or six months even when we are involved. And these are skilled, passionate advocates who take on these cases.”

Troubled hotline?
Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the agency will let seniors enroll in another plan even after the open enrollment season has passed if they were misled or given incorrect information. They should call 1-800-Medicare to see if they qualify, he said.

However, Sen. Gordon Smith, R-Ore., said Friday that his staff found the Medicare hot line to be of limited use. He said they called the number several times on June 17 because of concerns about a backlog in disenrollment claims.

There, they were greeted with long wait times, and a “dizzying array” of responses about disenrolling. The average wait time for calls successfully completed by his staff to 1-800-Medicare was 12 minutes. Many others never got through, Smith said.

Nelligan said the average wait time for all calls made to 1-800-Medicare on June 17 was 32 seconds. He said the wait for speaking to an operator was shorter than usual. Calls that didn’t get through may have been a result of local telephone network problems, not as a result of problems on CMS’s end.

As to the “dizzying array” of responses that Smith said his staff received, Nelligan said the agency takes reports of problems very seriously and works quickly to resolve them.

“We are looking closely at the concerns of Senator Smith in the same manner,” Nelligan said.

Smith, the ranking Republican on the Senate Aging Committee, said his staff is investigating reports of lengthy backlogs in the processing of disenrollment claims. He blamed part of the problem on Medicare officials not accepting some disenrollment files from the insurers.

“It is unacceptable for a Medicare beneficiary to wait up to three months to cancel their enrollment in an MA plan,” Smith said.

Smith asked for copies of call center scripts relating to disenrollment from private Medicare plans, as well as all guidance, advisories and other instruction letters issued on the topic.

Nelligan said agency officials believe it’s important to note that more than 8 million people are enrolled in Medicare Advantage plans, and the agency has logged just 2,700 complaints in the past four months about the plans, a strong track record.

In recent months, federal officials have said agents for some Medicare Advantage plans have used unscrupulous tactics to enroll seniors.

In Georgia, for example, the state insurance commissioner reports that one agent was arrested for fraud after allegedly signing up 10 residents at a home for the mentally disabled. Two other agents were arrested for conspiring to defraud seniors after they allegedly signed up people without their knowledge. They’re also accused of signing up dead people.

Seven of the leading companies offering a particular type of managed care plan for seniors, called private fee-for-service, have agreed to suspend the advertising of their plans until they fully implement new marketing requirements.

Meanwhile, Young said she continues to get mail from her old insurer: Last week’s letter started out “Dear Member.” The letter requested some basic health information so that the insurer could better serve her.

© 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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