topic To Whom do I complain about Insurance company malfeasance? in Medicare & Insurance

To Whom do I complain about Insurance company malfeasance?

aruzinsky — Wed, 11 Dec 2024 01:10:43 GMT

On the medicare.gov website, I see star ratings for insurance plans but I see no opportunity to review a plan. Among other things, Wellcare Ins. Co. apparently cancelled my OTCH account with CVS thereby robbing me of my debit card balance for over the counter drug store products.

Re: To Whom do I complain about Insurance company malfeasance?

mb12213371 — Wed, 11 Dec 2024 01:35:50 GMT

Why is AARP endorsing the worst healthcare provider with the most denials?

Re: To Whom do I complain about Insurance company malfeasance?

aruzinsky — Wed, 11 Dec 2024 01:56:27 GMT

The same reason that dogs lick their genitals, because they can.

And, you don't know the half of it. Oak Street Health, Inc is partnered with United Healthcare and AARP. In September 2024, the company paid $60 million to settle a lawsuit for violating the federal Anti-Kickback Statute. I have never seen a good review of Oak Street Health and, in my experience, Oak Street Health is a den of demons. See https://en.wikipedia.org/wiki/Oak_Street_Health .

Re: To Whom do I complain about Insurance company malfeasance?

GailL1 — Wed, 11 Dec 2024 03:32:41 GMT

@aruzinsky wrote

I see star ratings for insurance plans but I see no opportunity to review a plan

+++++++++++++++++++++

Why would you think that the star ratings come from info that a beneficiary submits- it isn’t. It is based on CMS’s own method of performance data and like most things mathematically founded, it is complicated, at least to me. it come from data which CMS collects from various sources.

https://www.cms.gov/files/document/fact-sheet-2025-medicare-advantage-and-part-d-star-ratings.pdf

In fact, a change that is being made in 2026 actually reduces some of the patients experiences -

The weight of Patients’ Experience and Complaints, and Measures Capturing Access measures will decrease from 4 to 2 beginning with the 2026 Star Ratings

https://www.cms.gov/files/document/2026-star-ratings-measures.pdf

Plus why would you think they would want to decrease a plans star rating in Medicare for a benefit that isn’t even sanctioned by Medicare - OTCH is an auxiliary benefit from the plan and I bet if you read the small print, one that they can cancel anytime. Seems that’s exactly what they did -

Lots of changes in MAPD and PD plans in 2025 because of the changes the Inflation Reduction Act has put upon the plan sponsors and drug manufacturers - therefore they are making back whatever money they can since they now have to spend more.

Sorry - you lost your benefit - did you review your plan for 2025 to make sure there were not some other changes that are going to affect you? - providers / meds or more auxiliary benefits. Like I said lots of plans have drastic changes for 2025 and some even disappear altogether.

Re: To Whom do I complain about Insurance company malfeasance?

aruzinsky — Wed, 11 Dec 2024 04:01:08 GMT

"Why would you think that the star ratings come from info that a beneficiary submits- it isn’t."
Because that's what star ratings customarily means, e.g, Amazon's star ratings.

"Plus why would you think they would want to decrease a plans star rating in Medicare for a benefit that isn’t even sanctioned by Medicare"
Already answered because, if it were a customer rating as I believed, it wouldn't matter what CMS wants.

"did you review your plan for 2025 to make sure there were not some other changes that are going to affect you?"
Yes, I switched to Essence.