Manage episode 236775150 series 1093150
Hey Medicare Nation!
Today, I'm discussing how the Centers for Medicare & Medicaid Services (CMS) SLAPPED Agewell New York LLC with a Civil Money Penalty of $39,200!
CMS conducts audits to ensure Medicare Advantage Prescription Drug Plans are following conditions of the current contract as well as Medicare rules & regulations.
From March 9, 2018 through May 15, 2018, CMS Conducted an audit of Agewell's 2016 Medicare financial information.
In a financial audit report issued on September 20, 2018, CMS auditors reported that Agewell failed to comply with Medicare requirements related to Part C (Medicare Advantage) cost sharing.
Specifically, auditors found that in 2016 Agewell failed to comply with cost-sharing requirements by charging "incorrect" co-payments to enrollees for medical services.
Enrollees were affected in the following area:
Bronx, NY; Kings County Brooklyn, NY; Nassua County, NY, Manhattan, Queens and Westchester County, NY.
Agewell's failure was "systemic," and "adversely affected" enrollees or the substantial likelihood of adversely affecting enrollees because they experienced out-of-pocket costs.
CMS determined that Agewell was charging a $30 "specialist" co-pay was applied to "primary care physician" claims instead of a $0 co-pay as stated in the plan's Explanation of Coverage.
Enrollees were NOT Refunded the overcharged amounts until AFTER the financial audit concluded, which was 2 years after the incurred cost.
In 2016, If you paid a $30 co-pay to see YOUR Primary Physician, when you were only obligated to pay $0, you should contact Agewell at 888-586-8044 and ask to speak to a supervisor, regarding the CMS penalty. Advise the supervisor of the date & time of your appointment with your Primary Doctor and that you have proof of a payment that you made of $30 for your visit. Advise the supervisor that you would like to be refunded the $30 immediately.
Write down the name of the supervisor, the date & time you called Agewell and what the supervisor stated Agewell would do for you.
If you donot receive your refund within 14 business days, call Medicare directly at 800-633-4227 and advise Medicare of the situation.
If you have any "complaints" regarding the way you were treated by any representative at Agewell, you can make an annonymous complaint to Agewell's confidential hotline - 888-336-7240.
You can also make a complaint to Medicare directly by calling 800-633-4227.
If you have a complaint, regarding any physician or facility in the Agewell network, you can call the Agewell confidential hotline to make your complaint - 888-336-7240.
If you are uncomfortable making a formal complaint and you would like assistance with your complaint you can :
1. contact the Insurance Agent or Medicare Specialist who enrolled you into the Agewell plan
2. contact your local "SHIP" (State Health Insurance & Assistance Program) representative by "clicking" on your State here - https://www.shiptacenter.org/
when the page opens, go all the way to the bottom of the page and you'll see an "orange" button that reads -
Find Your Local SHIP
"Click" on that ORANGE buton and a list will come up of all 50 States.
"Click" on the State where you reside, to contact your local SHIP center.
If YOU need help with finding the Medicare Advantage Plan that is right for your UNIQUE needs, contact me at either:
call me at 855-855-7266
If I can answer your question in ONE paragraph in an email, I will directly answer your question!
If it takes more than one paragraph to answer your question or I need to do research to answer your question....then....I will respond by advising you that you will need to contact me and request my consultative services.
I currently charge $199.00 an hour, and I consult with Medicare beneficiaries and the Adult Children of beneficiaries ALL over the country!
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