Sep 10, 2009 9:05 pm US/Central
Woman's Medicare Coverage Was Switched
Catherine Sims, 70, Was Denied Cancer Treatment Under New Insurer
CHICAGO (CBS) ―
-
-
Catherine Sims says her Medicare coverage was switched without her consent, jeopardizing her chemotherapy treatment.
CBS
Millions of Medicare patients will be getting barraged next month with confusing offers to enroll into a new or better plan.
They can learn from what happened to one woman who either made the wrong choice or was misled by a company with a history of deceptive practices and failures to provide adequate services.
As CBS 2 Investigator Pam Zekman found out, she's falling through the cracks of our health care system.
Seventy-year-old Catherine Sims was anxious to receive her first chemotherapy treatment last month.
"Her spirits were up and she was like as long as I get this medication I can live," Vanita Williams, Sims' daughter, said.
But Williams says after they got to her doctor's office, they were preparing the treatment but stopped.
"An employee said there was a problem," she said. "WellCare had denied the medication and that they were not going to be able to administer the chemo and that we had to leave. Well, at that point, we were devastated."
Since then, Vanita Williams has tried to figure out what's going on with her mother's insurance coverage.
She had Medicare and Blue Cross Blue Shield, so it was confusing, Williams said.
WellCare Health Plans, based in Tampa, has more than 1 million beneficiaries enrolled nationally.
Catherine Sims became one of them around December and she was in good health, according to her daughter.
That's when a WellCare benefit consultant signed her up.
Williams says her mother thought it was just for vision and dental care to bridge gaps in her current coverage.
But WellCare produced a document showing she enrolled in a program that switched all of her insurance coverage to their company, as disclosed in this warning.
"I didn't know it if I did," Sims said.
"If you could find the salesman who sold you the WellCare what would you do?" Zekman asked her.
"I think I'd slap him," she said.
Last February, the U.S. Department of Health and Human Services did much more than that to WellCare. The agency ordered the company to stop enrolling any new beneficiaries as a result of thousands of complaints and audits done by the agency starting in 2007.
"We are trying to make sure that the beneficiaries are protected, that they are receiving the care they are entitled to under Medicare," agency representative Liz Lopez-Cepero said.
The agency said WellCare and its agents provided "inaccurate or misleading information to potential enrollees" and "failed to adequately monitor and correct the practices" or "discover forged applications," among other serious violations.
"I don't understand," Williams said. "They had knowledge of the deception and everything. Why did they allow it to continue?"
Good question.
"There are additional steps that can be taken if WellCare does not continue to improve, such as terminating the contract," Lopez-Cepero said.
"This has been a nightmare," Williams said. "I love my mom and I want her to have the best possible chance that she can have. She's fighting for her life."
WellCare declined to comment specifically on Sims' case. But a spokeswoman said the company policy does not deny chemo treatment to any beneficiary.
The company says decisions about giving treatments are up to the treating doctor. Sims' doctor declined to talk with us.
WellCare also says its implemented numerous improvements to correct deficiencies cited by the government. Without admitting guilt, WellCare has also paid $80 million to settle a separate criminal health care fraud case in Florida.
For information about Medicare coverage, click
here. You can also call (800) MEDICARE.
(© MMIX, CBS Broadcasting Inc. All Rights Reserved.)
Jewish Celebrities
Click to enlarge
Stumble It!
Reporting
