The Government Accounting Office has done an audit of how well the help lines operated by the various insurance providers (under government funding) answer customer's questions about Medicare Part D.
Their results shouldn't be too surprising. As the NY Times summarized the report:
Federal investigators said Monday that Medicare prescription drug plans generally provided incomplete and inaccurate information to callers who asked questions about the new benefit.
The findings, from the Government Accountability Office, a nonpartisan investigative arm of Congress, are significant because the premise of the new program is that consumers will make informed choices among dozens of competing plans.
The second paragraph is key. Indeed, how can consumers be expected to make informed choices if they cannot get accurate information about the plans?
Links:
The New York Times article (Registration required)
The actual GAO report (PDF)
More details below the fold
Investigators placed 900 calls to 10 of the largest companies that offer drug coverage to Medicare beneficiaries. They reached customer service representatives in 864 calls.
The plans provided accurate, complete responses to one-third of the calls, 294 of the 864. Twenty-two percent of the 864 responses were inaccurate, 29 percent were incomplete, and no answers were provided to the other questions.
Two of the 10 companies gave inaccurate or incomplete information at least 75 percent of the time, the report said. And operators at the same company sometimes gave different answers to the same question.
The government agency responsible for overseeing the insurance companies took some issue with the GAO's methodology.
In an interview on Monday, Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, said that one question posed to insurers was "unclear and inaccurate" and that two were "not appropriate" because they required the service representatives to provide more information than the government required. Insurance counselors said many beneficiaries were unfamiliar with details of the program, so their questions were imprecise or confused.
Well, it's no suprise that beneficiaries would be unfamiliar with the details of the program so their questions were imprecise or confused. Isn't that the whole point of having a call center to help educate them as well as answer their questions? I eventually dug up the actual GAO report because I was trying to understand what McClellan meant by his objections.
I found the 5 questions that were asked. They were:
1. My mother takes the following drugs: Norvasc, Fosamax, and warfarin sodium. Which of the sponsor's plans would cost her the least amount annually and what is its annual cost?
2. My mother-in-law takes the following drugs: Aciphex, Benicar, Evista, Levoxyl, Pravachol, Synthroid, Zetia, and Zoloft. Which of the sponsor's plans would cost her the least amount annually and what is its annual cost?
3. My mother automatically qualifies for extra help because Medicaid pays part of her Medicare premiums. Does the sponsor offer a plan that she can join without having to pay a premium?
4. If some of my grandfather's drugs are not covered, will he have to pay full price for them, or are there other things he can do?
5. If some of my grandfather's drugs are covered, but subject to restrictions, what does that mean?
These questions didn't seem to be particularly unclear or inaccurate. These are the types of questions that I answered routinely as a volunteer helping with Medicare Part D at my local senior center.
The report goes into quite a bit of detail about the various objections CMS stated to the wording of the questions asked and how the responses were evaluated. Here's one example to give you an idea of the type of quibbling that was going on:
CMS also took issue with how we counted a specific CSR response to questions 1 and 2. The agency incorrectly claimed that a CSR's referral to 1-800-MEDICARE was categorized as an incomplete response. As noted in the draft report, we categorized responses as incomplete if the CSR accurately named the lowest annual cost plan, but either inaccurately calculated or could not provide the annual cost. If the CSR did not answer the question and instead referred the caller to 1-800-MEDICARE for information on PDPs, we classified the response as "no answer provided."
The report's concluding observations:
Our calls to 10 of the largest PDP sponsors' call centers show that Medicare beneficiaries face challenges in obtaining the information needed to make informed choices about the PDP that best meets their needs. Call center CSRs are expected to provide answers to drug benefit questions and comparative information about their sponsors' PDP offerings. Yet we received accurate and complete responses to only about one-third of our calls. In addition, responses to the same question varied widely, both across and within call centers. Sponsor call centers' poor performance on our five questions raises questions about whether the information they provide will lead beneficiaries to choose a PDP that costs them more than expected or has coverage that is different than expected. Rather than consider PDP options solely on the basis of the call centers' information, callers may benefit from consulting other information sources available on Medicare Part D when seeking to understand and compare PDP options.
Thank goodness for the GAO for pointing out these glaring deficiencies in the insurance companies' help lines. I wonder how long it's going to take the Republicans to start dismantling the GAO...