Insurers faulted on drug advice

WASHINGTON — WASHINGTON -- Federal investigators said yesterday that the Medicare prescription drug plans generally provided incomplete and inaccurate information to callers who asked questions about the new benefit.

The findings, from the Government Accountability Office, a nonpartisan investigative arm of Congress, are significant because the premise of the new program is that consumers will make informed choices among dozens of competing plans.


Investigators placed 900 calls to 10 of the largest companies that offer drug coverage to Medicare beneficiaries. They reached customer service representatives on 864 calls.

The plans provided accurate, complete responses to one-third of the calls, 294 of the 864. Twenty-two percent of the 864 responses were inaccurate, 29 percent were incomplete, and no answers were provided to the other questions.


Two of the 10 companies gave inaccurate or incomplete information at least 75 percent of the time, the report said. And operators at the same company sometimes gave different answers to the same question.

Insurers typically offer two or three Medicare drug plans in each state. They have different premiums and co-payments and cover different drugs.

The GAO said, "Relatively few customer service representatives were able to accurately identify the least costly plan and calculate its annual cost."

When they correctly identified their least costly plans, they usually "provided a quote that was less than the actual cost," the report said.

Insurers failed to provide complete and accurate cost information more than 70 percent of the time, investigators said.

For people taking large numbers of prescription drugs, the disparity between the stated cost and the actual cost was often thousands of dollars a year, more than $6,000 in one case.

Because of the "poor performance" of call centers, the study said, beneficiaries may often choose drug plans that cost more or provide less coverage than they expected.

The Bush administration took issue with the report and defended the work of the plans. The administration said the auditors should have asked different questions or should have phrased the questions differently. But it agreed that "beneficiaries should be able to count on the customer service."


The drug benefit is provided by insurance companies under contract to the government. Medicare requires them to answer phones promptly, but the GAO said the Medicare agency "has established no performance requirements" for the accuracy of answers given to callers.

Democratic Rep. Pete Stark, of California, one of five House members who requested the study, said: "It's not enough to simply answer the phone. Medicare should guarantee that plans provide accurate and complete information."

The experience of Josephine M. Arno of San Diego appears to illustrate the problem. Arno said she had been frustrated in trying to obtain information to help her mother-in-law enroll in a Medicare drug plan.

"The customer service representatives could not tell me what the premium, deductible and co-payments would be," Arno said. "They did not know what I needed to do to get extra help for my mother-in-law."

Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, said yesterday that one question that was posed to insurers was "unclear and inaccurate" and that two were "not appropriate" because they required the service representatives to provide more information than the government requires.