- 1,107
As the biggest Medicare Advantage insurers see it, something as minor as a dropped phone call can now cost them hundreds of millions of dollars.
Around the time Medicare open enrollment started last month, the insurance giants Humana, Centene and subsidiaries of UnitedHealthcare filed lawsuits alleging they stand to lose substantial revenue because a tiny number of unsuccessful customer service phone calls hurt their 2025 Medicare Advantage scores — costing them customers or multimillion-dollar bonuses they otherwise stood to get from the federal government.
“These are staggering consequences for a single call,” Centene said in its lawsuit, which claims the company and its subsidiaries will lose $73 million in gross revenue.
Ratings fell on at least a dozen of Humana’s largest plans because of three anonymous phone calls meant to test whether the insurer provides language interpreters, according to the company’s lawsuit, which was filed in federal court in Texas.
Humana alleges two of the calls were disconnected because of third-party internet problems. During the third call, neither the Humana representative nor the government caller spoke. After an extended period of silence, the call was disconnected, the lawsuit said.
Similar phone calls were at issue in the UnitedHealthcare, Centene, Elevance and Scan lawsuits. Centene lawyers said the disputed call never reached the call center and blamed software the contractor used. UnitedHealthcare’s lawsuit alleges the government caller did not ask a required introductory question.
https://www.washingtonpost.com/business/2024/11/04/medicare-advantage-ratings/
Around the time Medicare open enrollment started last month, the insurance giants Humana, Centene and subsidiaries of UnitedHealthcare filed lawsuits alleging they stand to lose substantial revenue because a tiny number of unsuccessful customer service phone calls hurt their 2025 Medicare Advantage scores — costing them customers or multimillion-dollar bonuses they otherwise stood to get from the federal government.
“These are staggering consequences for a single call,” Centene said in its lawsuit, which claims the company and its subsidiaries will lose $73 million in gross revenue.
Ratings fell on at least a dozen of Humana’s largest plans because of three anonymous phone calls meant to test whether the insurer provides language interpreters, according to the company’s lawsuit, which was filed in federal court in Texas.
Humana alleges two of the calls were disconnected because of third-party internet problems. During the third call, neither the Humana representative nor the government caller spoke. After an extended period of silence, the call was disconnected, the lawsuit said.
Similar phone calls were at issue in the UnitedHealthcare, Centene, Elevance and Scan lawsuits. Centene lawyers said the disputed call never reached the call center and blamed software the contractor used. UnitedHealthcare’s lawsuit alleges the government caller did not ask a required introductory question.
https://www.washingtonpost.com/business/2024/11/04/medicare-advantage-ratings/
