On Medicare D? The abyss you will encounter known as 'Customer Service'

From Frank Kaiser, July 07

Subject: [SeniorNews] Abysmal customer service provided by the Part D plans - from Suddenly Senior

Asclepios

Your Weekly Medicare Consumer Advocacy Update

Ring Ring!

July 6, 2006 · Volume 6, Issue 27

One of the most common complaints from people with Medicare during the chaotic first six months of the Part D drug benefit was the abysmal customer service provided by the Part D plans. People could not get through to the plans' 800 numbers. When they did get through, they were put on hold, often for more than one hour. After they were put on hold, they were disconnected.

When customer service did pick up, very often they could not provide a useful answer:
* They could not tell what drugs the plan covered;
* For covered drugs, they could not explain what restrictions were imposed;
* They could not inform callers about how to appeal for coverage;
* They could not explain when the coverage gap would be reached;
* They could not correct billing errors.

The list goes on. The Bush administration downplayed the problems because it was determined that Part D appear to be a success, whether it was or not. If people with Medicare cannot get the most basic kinds of consumer information, then a model based on competition and "choice" makes no sense. If Part D plans can't deliver, then Medicare should deliver the drug benefit. A simple, standard and comprehensive Medicare drug benefit would make most of the frantic calls to customer service unnecessary, and eliminate the nearly impossible task of overseeing the performance of more than 80 companies offering Part D plans.

The administration's PR effort largely failed, because this time, reality overwhelmed spin. But that has not stopped the spinmeisters. Last week, the Centers for Medicare & Medicaid Services (CMS) released the first data comparing the Part D plans' customer service. Despite repeated requests, however, CMS did not release information showing whether the Part D plans are meeting the minimum customer service requirements established by the agency. Instead, CMS set up a new test designed so that all plans would pass, and . . . they all did.

CMS asked the plans, whether, on average, they answer their customer service lines and their direct lines for pharmacists within five minutes. Not surprisingly, except for a couple of bad actors who refused to answer, they all said "Yes."

Ring Ring!

Now, 5 minutes is a long time to wait for someone to pick up the telephone, especially if you are a pharmacist with a line of customers at the counter. An average of five minutes to answer a call tells you next to nothing about the plan. How many calls were answered promptly? How many had wait times in excess of 30 minutes? How many calls were dropped? And finally, how many calls were answered correctly?

Instead of setting up this bogus test, CMS should hold plans to account on the customer service requirements it has already laid out: Part D plans must answer 80 percent of calls within 30 seconds, not five minutes, and cannot drop more than 5 percent of all calls. Call centers are also required to provide thorough information on benefit coverage, respond to inquiries and handle customer complaints, and explain in detail how to appeal for coverage. When will consumers find out how the Part D plans measure up according to these standards? When will CMS release information on how the plans handle grievances and appeals and on how often plan members run into barriers to access, like prior authorization requirements?

We're waiting.

Write CMS Administrator Mark McClellan asking that consumer information be made available at http://www.medicarerights.org/action/index.html