Financial Exploitation of a 99 1/2 year old woman on Hospice care, by AARP United Health Care plans

[toodles04]

I have a long and painful story about my mother, now deceased as of 4/22/2023, who was financially exploited (qualifying as elder abuse) by AARP's United Health Care plans - both supplemental insurance and prescription insurance.  To whom in the system should I address my complaint?  

Thank you, 

Dr. Shelley P. Caswell-Moore

[GailL1]

You have to give details - because I think this is a dangerous claim without giving details.  

Medicare (Part A) covers ALL of Hospice care - with a small copay for meds - like $ 5.00.  In fact, not even a Medigap plan has to pay any for Hospice care since it is covered at 100% rate by Medicare.

Now it is important to understand exactly what Hospice is - it is a defined coverage item.  Things outside of it, if medically necessary that is covered by Traditional Medicare + Medigap are still covered as long as they don’t relate or conflict to the Hospice coverage.

Maybe it would help to read up on Medicare Hospice - a few links

Medicare.gov - Hospice Care Coverage

Medicare.gov - Medicare Hospice Benefit

Medicare.gov - How Hospice Works 

To answer your specific question 

If the links don’t give you a solution - address your concerns to UHC cause AARP is not involved in the actual insurance - they only sell their branded name for financial support of their programs.  

[LaDolceVita]

Hospice can be tricky.  They do not pay for medicines which are not related to the condition for which hospice  is needed.  Also sometimes the person on hospice may need to be hospitalized, during which time they are removed from hospice and later reinstated.  

I switched my mom from Medigap and part D to Medicare Advantage after she was accepted for hospice.   This worked well for her RX and also when she was confined to the hospital for an emergency.  I did have a pretty hefty out of pocket for the hospitalization but saved a great deal on Medigap premiums.

[toodles04]

My mom would never have gone to a hospital, no matter what. She wanted to stay where she was and have comfort care. That is it. She knew she would never again need or want her Part D script insurance for supplemental insurance. She was 99 1/2 and ready to die. 

[toodles04]

The issue has nothing to do with Medicare or Hospice. The problem is that my mother tried numerous times via snail mail, fax, and phone, to cancel both her UHC plans due to the coverage she had with Hospice and knowing she wasn't going to need/use anything else. We have a paper trail of her attempts, and for months, she continued to get billing statements. Every month she wrote back saying she had canceled, providing her documentation. Each month, UHC wrote her back acknowledging that she was trying to cancel and each month giving her a different explanation of what she had "done wrong." She tried her best - she was hard-of-hearing, old, frail, and dying. But she was cognitively intact and knew exactly what she was doing. Where is the advocacy for our venerable older adult population in this scenario?  Where is the compassion?  What kind of customer service is this? 

As recently as yesterday, my sister (Executor) spent 6 hours on the phone with UHC being given the "run-around" just like our mom had been given.  At one point, while my sister was on hold, UHC turned this $309 bill over to a collection agency!!  Where is the respect and understanding for a nonagenerian (almost 100 years old) who had, in all good faith tried to cx her coverage to save money as many people on fixed incomes would do? 

This is surely UHC's business, but we have already tried talking to them.  AARP endorses UHC plans - it is right on all the literature and insurance cards. 

As a gerontology professor, I can assure you that this kind of treatment for a 99 1/2 year old American, is reprehensible at best.  The family feels that our mother was taken advantage of due to her age and frail condition and that she was mistreated by a large organization that is supposed to be a friend and advocate for older adults. 

[GailL1]

I believe your problem has more to do with the Medicare rules of enrollment / disenrollment on the part D coverage (PDP)

• there are SPECIFIC time periods when one can switch or cancel prescription drug plans.  I'm thinking that's what UHC was trying to tell her.

Medicare.gov - How to drop your Medicare drug plan

also notice the specific heading of this in the link

Can I drop my Medicare drug plan outside the Open Enrollment Period?

You can't drop your Medicare drug plan outside the Open Enrollment Period unless you meet certain special circumstances.

Were there any claims put through from Medicare to the Medigap plan after she notified them of cancellation?  Her Medicare account should have shown that the Medigap coverage was terminated and any amount that may have been due from them for something other than Hospice would have been billed to her.

Like I said, Hospice is pretty complete coverage (and I hate to sound cruel adding this next thing) as long as one knows they will be dying shortly (very shortly).  

The thing is if she had fallen and broken something as an example - Hospice would not cover that condition - not the treatment and not any meds she might get for pain from it. 

One of the ways to have a Medigap plan or a PDP cancelled is to stop making premium payments - but that does take time for it get from the beneficiary thru the insurer to her actual Medicare account.

I understand your frustration but remember this is insurance and insurance doesn't work unless people pay into it - that's the reason why Medicare has penalty rules if people don't get coverage when they are supposed to - 

[toodles04]

My mother's initial contact with them was squarely within the enrollment period. They gave her a terribly hard time, and it really hurts to know what she went through, according to her documentation. She kept meticulous notes.  Also, the nurse at her assisted living facility helped her with faxes, phone calls, and snail mails. 

[GailL1]

@toodles04 

Let’s look at these different coverages - one by one.

1.  Supplemental Medicare coverage - a/k/a MEDIGAP”. 

This is NOT health insurance - it is a financial insurance product sold by insurance companies which is GAP insurance - depending upon the Medigap plan which she picked and paid monthly premiums - it picks up any approved Medicare coverage cost to the insurer - her out of pocket expenses.

ALL she had to do to cancel a Medigap policy is to tell the insurer to cancel it - or stop making the monthly premium payment and they would stop coverage.

2.  Prescription Drug Coverage - she had to keep this because she probably had some meds or could have in her last days to make the “comfort” easier - be that pain meds or anxiety meds and perhaps others.  

Also it she was on some maintenance meds like insulin, high BP, cardiovascular - those would continue UNLESS the doctor removed her - and that is most unlikely especially for things like insulin which withdrawal from it could cause immediate death -   That’s not how doc’s work.

Even if Medicare under the Hospice benefit is paying for most of her meds except the $ 5.00 copayment - that does not mean that the prescription drug company isn’t still paying their share of the WHOLE cost of the meds to cover them.

So if she had successfully cancelled her Part D Prescription Drug Coverage - she would have had to pay MORE for any meds she was getting or might get in Hospice than the $ 5.00 co pay.

I am hoping that these were the Medicare free-standing plans that she was on - Traditional Medicare, Medigap + a free-standing Medicare Part D plan for prescription drugs.

Medicare does NOT look at the age of any patient - that does not play into any benefits inclusion.  

Some people go in and out of Medicare Hospice care sometimes. 

Some people have something come up that isn’t covered by Hospice - I gave you an example of a bone break which could always happen - This would not be covered by hospice and would still have to be treated - and if she had cancelled these other parts of her Medicare coverage - she would have had to pay ALL of her out of pocket cost - treatment and Medicine cost - 

Medicare is insurance - Insurance is congregate coverage - everybody pays in to get the benefits - It has little to do with compassion - this is insurance / money of which it is a system for over 60 million people.

I am sorry for your loss - 

One more caveat - now if your mother had a Medicare Advantage plan with a built-in prescription drug coverage instead of traditional Medicare + Medigap + free-standing Medicare prescription drug plan as I have described above - the end results would have been the same but just under different rules and insurance payers.  Some folks that don’t know how Medicare works and the choices one has under the program, sometimes confuse the different plans.

[toodles04]

Let's look at your responses - one by one.

1. My mother DID cx her plan, numerous times in numerous ways, within the enrollment period. 

2. PD coverage - all her maintenance drugs were discontinued (she was only on one). She only took what was provided by Medicare Hospice, and very little at that.  A $5 co-pay is one thing, that's fine.  It is the overdue charges to my deceased mother that I take issue with after she had cx'ed her coverage. 

Yes, I understand that sometimes people go in and out of Hospice care, but it isn't likely for an 80 pound, 99 1/2 year old woman, now is it? 

Your remark "Medicare is insurance - Insurance is congregate coverage - everybody pays in to get the benefits - It has little to do with compassion - this is insurance / money of which it is a system for over 60 million people."

My mother paid into this system for decades.  She used it very little. Oh, and how rude to say it has little to do with compassion.  Perhaps I will scan and post my mother's communication with the customer service reps so that everyone on this thread will see the LACK OF COMPASSION imparted to my mother.  Within 2-3 weeks of her death she was begging them to please see all previous communication and do what they said they would do - she asked them to leave her in peace! She had done everything multiple times. 

The only reasonable thing you have insinuated is that the plans can be confusing.  Maybe AARP should help older adults sift through it all instead of marketing gap plans that cost a great deal of money and have many "gotcha's" in them.  I have also noticed through my mother's records that she kept - she paid AARP's membership renewal earlier and earlier and earlier each year, costing her more and more money - this is a rip off as well. Another gimmick to make money. I have noticed this as well.  I won't be falling for that again myself either.  

If you think this issue is resolved, it isn't.  A simple apology for not more effectively assisting an elderly woman would have been a start.  I firmly believe that AARP and United Health take advantage of older adults instead of advocating for them.