Minnesota Attorney General Lori Swanson today asked the federal agency responsible for regulating private Medicare insurance policies to investigate and remedy complaints by Minnesota senior citizens about improper claims handling by Humana, which sells private Medicare policies in Minnesota.

In a letter containing over 25 sworn affidavits from Minnesota patients and medical providers, Attorney General Swanson called on the federal Centers for Medicare & Medicaid Services (“CMS”), which regulates private Medicare plans, to investigate and remedy any violations of federal regulations arising from Humana’s improper claims handling in Minnesota. The United States Congress has determined that states are preempted from regulating benefit determinations of private Medicare Advantage plans and has vested jurisdiction to regulate such plans with CMS.

“Medical bills that aren’t covered or processed properly can hit senior citizens hard in the pocketbook. We are asking the federal agency that has authority over these plans to fully investigate and remedy the problems experienced by Minnesota patients,” said Swanson.

Medicare Advantage plans are private health plans approved by CMS, but sold and administered by private insurance companies as an alternative to traditional Medicare fee-for-service coverage. Medicare Advantage plans may provide prescription drug coverage and include mandatory or optional supplemental benefits such as vision and dental benefits. Minnesota has the highest number of enrollees in Medicare Advantage plans in the nation on a per capita basis, according to a June 2013 report by Kaiser Family Foundation.

In her letter, Attorney General Swanson cites numerous problems reported by Minnesota patients and providers about Humana, including:

1. Denial of claims involving Medicare-covered services. (Other than hospice care, Medicare Advantage plans must cover anything traditional Medicare would cover.)
2. Overcharges for co-payments and co-insurance.
3. Failure to adequately disclose what providers are in network and to update its network provider directories.
4. Failure to follow the appeal procedures required by federal regulations.

Humana is a publicly traded, for-profit insurance company. It is one of the biggest insurers in the Medicare Advantage market nationwide, offering at least one type of Medicare Advantage plan in all 50 states. About 17 percent of all Medicare beneficiaries nationwide are enrolled in a Humana Medicare Advantage plan, according to a June 2013 report by Kaiser Family Foundation.

The Attorney General’s Office provides this advice to Medicare beneficiaries who are thinking about enrolling in an Medicare Advantage plan:

1. Determine if your health care providers are in-network.
2. Identify the copays, deductibles, and out-of-pocket maximum costs for the plan. Plans’ costs will vary, especially for in- versus out-of-network care.
3. Determine if supplemental benefits are offered by the plan.

People may report complaints against Humana to the Minnesota Attorney General’s Office by calling (651) 296 3353 or (800) 657 3787. Individuals may also download a Complaint Form from the Attorney General’s website by clicking here and mail the completed form to the Attorney General’s Office at: 1400 Bremer Tower, 445 Minnesota Street, St. Paul, MN 55101 2131. People should also contact CMS directly about this problem by calling CMS at 1-800-633-4227 or by writing to its Administrator, Marilyn Tavenner, at Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201.

Source:
ATTORNEY GENERAL SWANSON ASKS FEDERAL AGENCY TO INVESTIGATE COMPLAINTS AGAINST HUMANA BY MEDICARE PATIENTS