Medicare Advantage insurers fear losing millions over a few bad phone calls

[Duaine]

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/

 

[somarco]

 

[Special Agent]

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/

They must have reached customer service agent Peggy.....

 

[InsuranceGuy29]

That’s all of our commission money going bye-bye. These plans are graded on an insanely strict level. Like INSANELY strict. I understand them needing to be held accountable, but yanking money away for dropped calls (something totally out of anyone’s control) is pretty effng ridiculous.

 

[vic120]

Ok I cant read the article

what is going on here?

Are they saying there needs to be some call with disclaimers to Enrolment to go through

are they saying we can lose deals even after they are showing approved in portal?

Or does this just have to do with their own in house enrollments?

 

[Bob L]

Ok I cant read the article

what is going on here?

Are they saying there needs to be some call with disclaimers to Enrolment to go through

are they saying we can lose deals even after they are showing approved in portal?

Or does this just have to do with their own in house enrollments?

Vic, I used to work as an in-house sales rep at Cigna in Nashville ten years back. These calls are only for plan sponsors' call centers. It is CMS's way to verify that people who speak nothing but Swazi or Mongolian can readily access Medicare plans.

We occasionally would answer the phone and hear a distant lady's voice saying "Tagalog," for example, and we would need to 3-way in the translation service and ask for a Tagalog translator. It was stressed that we should be very careful not to mess up as dire consequences would result with CMS. One agent I knew quit because she could not handle the stress.

Sometimes it sounded like some el cheapo VOIP connection with a lot of background noise. I will admit to getting a tad nervous myself once in awhile when receiving those stupid calls. It was super easy to accidentally push a wrong button or misdial when under stress like that, if you didn't have your head on straight and stay calm.

The carriers have a legitimate complaint -- this whole language thing is preposterous, at least the fact that it has such a large effect on star ratings.

 

[InsuranceGuy29]

Vic, I used to work as an in-house sales rep at Cigna in Nashville ten years back. These calls are only for plan sponsors' call centers. It is CMS's way to verify that people who speak nothing but Swazi or Mongolian can readily access Medicare plans.

We occasionally would answer the phone and hear a distant lady's voice saying "Tagalog," for example, and we would need to 3-way in the translation service and ask for a Tagalog translator. It was stressed that we should be very careful not to mess up as dire consequences would result with CMS. One agent I knew quit because she could not handle the stress.

Sometimes it sounded like some el cheapo VOIP connection with a lot of background noise. I will admit to getting a tad nervous myself once in awhile when receiving those stupid calls. It was super easy to accidentally push a wrong button or misdial when under stress like that, if you didn't have your head on straight and stay calm.

The carriers have a legitimate complaint -- this whole language thing is preposterous, at least the fact that it has such a large effect on star ratings.

1,000% this. But hey, people vote for this extremist, draconian, authoritarian, liberal insanity.