Unpaid claims. Coverage Denied. Liquidation.
These are not words you want associated with your health insurance company.
But that's what happened to 38,000 Floridians with Physicians United Plan policies. Last month, the state took over the insolvent Medicare Advantage plan because it ran out of money. The company known by the cute nickname of PUP is more than $13 million in debt.
Tampa insurance agent Bill Hagar sold about 100 PUP policies, including one to himself. Several clients - including two with cancer and one undergoing knee surgery - told him their doctors were getting stiffed.
"I had suspicions that PUP had some financial difficulties earlier this year,” he said. “There were a number of my members that had legitimate claims, they followed the legitimate in-network processes and approvals, and yet their bills were not paid."
Hager got fed up and quit working for the Orlando company months ago. He's reached out to some seniors who bought PUP policies from him. And he says he understands why some clients yell when he calls. He tells them he was fooled, but now wants to help.
"It feels disappointing because I acted in the best interest, their best interest. And I did what I thought was best at the time,” he said. “Like I said earlier, I signed myself up for a PUP plan, because I saw the benefits and it sounded very good. And it wasn’t."
More than 3.5 million seniors in Florida have health insurance through Medicare, and they depend on it for doctor's visits, medications and trips to the hospital. About 40 percent of them choose a Medicare Advantage plan, where a private insurer manages their coverage.
These HMOS – including Physicians United – attract seniors with extra benefits, and lower premiums and out-of-pocket expenses.
Florida's Department of Financial Services is overseeing the liquidation of Physicians United. It set up a call center to help members deal with unpaid claims from before June 1. It's also providing information on its website and in mailings to help answer questions about all that's happened.
Since June 1, the former PUP members have been enrolled in original Medicare. They now have to pay $105 a month in premiums, which they didn't have under Physicians United. Co-payments and deductibles are higher, too.
“PUP members are advised to very carefully read any letters received from the (DFS) or CMS (the Centers for Medicare and Medicaid Services). These letters provide extremely important information regarding the continuation of the member’s health care coverage, including arrangements made for continued prescription drug coverage, and explain the member’s other Medicare options,” DFS spokeswoman Ashley Carr said in a statement.
She added it’s important that former PUP members know they are NOT liable to any health care provider for services covered by the HMO plan, under Florida Statute 641.3154.
“Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO members for such services. Members who are contacted by a health care provider for such payment should inform the provider of this law," she said.
In regards to picking new plans, it’s important PUP members know that unless they select a plan that picks up some of the costs, they'll continue to have the higher expenses on original Medicare, said Lee Champagne, a counselor with SHINE, Florida's free insurance counseling program for seniors.
"Things have changed. Their co-pays have changed for their medicines and their doctor’s visits for the most part,” he said. “But they need to make decisions about where they are going pretty quick."
Officials with the Centers for Medicare and Medicaid said Physicians United Plan members will have until Aug. 31 to select another Medicare plan.
Champagne said members need to decide first what's most important, such as being able to keep their favorite physicians.
"One of the questions we hear a lot is do I have to change doctors. Some of the people have had the same primary care physician for years and they don’t want to change,” he said. “So they need to find out what other insurance does the doctor accept?”
Hager, the insurance agent, understands why some of his former PUP clients yell when he tries to contact them. And yes, he's still selling Medicare Advantage plans, but now for a national provider with a high score on the government quality rating system.
Forget all the enticements. Hagar said he now looks at flat-out facts.
“I would check out the highest-rated plans possible and evaluate it just on that. Never mind all the benefits. How high are they rated by the government?” Hagar asked. “I do trust in their rating because they are very, very strict."
SHINE counselors like Champagne never recommend what Medicare plan seniors should choose. And so far, most PUP members he has talked with want another Medicare Advantage plan and not the guaranteed original Medicare. They say the cost savings and benefits offered outweigh the financial risks that come with a private company.
"But it can happen with any plan. You know, the larger plans, some people might say…are never going to fail. Well you never know,” Champagne said. “Medicare is going to be around. And HMOs and PPOs come and go. And that may be looked at for one of the advantages of signing up for original, traditional Medicare.”
Every Medicare policy holder can learn something from the problems surrounding Physicians United, Champagne said. They can use that hard-won knowledge during Medicare's yearly open enrollment period. This year, it will be October 15 to December 7.
"It’s easy to do nothing during open enrollment or this special enrollment,” he said. “But you really should look at it. It’s amazing how much money you can save by looking at other plans."
IMPORTANT NUMBERS:
Claims: For information and assistance on claims, PUP members can call the Department of Financial Services call center at (800) 882-3054 (Florida only) or (850) 413-3081.
Plan Options: Physicians United plan members can call (800) MEDICARE (1-800-633-4227) to see what plans are still available in their region.
Free Counseling: Call the Florida State Health Insurance Program (SHINE) at 1-800-96ELDER to schedule an appointment.
Medicare Supplement plans: For information regarding Medicare Supplement options, members can call (877) 693-5236 (Florida only) or (850) 413-3089.
--Health News Florida is part of WUSF Public Media. Contact Reporter Mary Shedden at (813) 974-8636, on Twitter @MaryShedden, or email at shedden@wusf.org. For more health news, visit HealthNewsFlorida.org.
