Insurer penalty affects Triad

Mar 6, 2010 — Winston-Salem Journal

Richard Craver

Mar. 6, 2010 (McClatchy-Tribune Regional News delivered by Newstex) -- Officials with the N.C. Department of Insurance have identified nearly 3,800 residents in the Triad and Northwest North Carolina who are affected by Medicare's suspension of a New York insurance company's marketing and enrollment programs.

The suspension, announced Feb. 26, involves the Part D prescription-drug plans for Fox Insurance Co. The beneficiaries, many of whom qualify for the low-income subsidy under Part D, are in 21 states.

Guilford County has the most affected beneficiaries at 851, followed by Forsyth County at 658, according to the state insurance department. Nearly 24,000 people are affected statewide.

The federal Centers for Medicare and Medicaid Services said that the Fox drug plan has not been able to meet the prescription-drug needs of some of its newest members, "actions which could pose serious threats to their health and safety."

The agency said it received complaints from recipients and their doctors, although none were made in North Carolina, according to the insurance department.

If Fox fails to comply with Medicare guidelines, it could face fines or termination of its Medicare contract.

The insurance department said that Fox was requiring prior authorization and step therapy when filling prescriptions -- requirements not approved by Medicare. It also was not meeting necessary appeals deadlines and requirements for shifting new enrollees to the covered drugs.

Medicare said that the problems could result in delays in therapies and prevent access to prescriptions -- mostly involving drugs used for treatment of cancer, HIV/AIDS, seizure disorders, diabetes and respiratory disease.

Kristin Milam, an insurance-department spokeswoman, said that many beneficiaries are in the "dual eligibility" category for Medicare and Medicaid related to the low-income subsidy. They are automatically enrolled into a Plan D plan by Medicare.

Beneficiaries can get help immediately by contacting the Seniors' Health Insurance Information Program, Milam said.

The program, offered through the insurance department, provides free information about Medicare, Medicare prescription-drug coverage, Medicare Advantage, long-term-care insurance and other health-insurance information. More information can be found at www.ncshiip.com.

"They have the option monthly of changing their Plan D plan until they get the right fit," Milam said. "Those enrolled with Fox, but not part of the low-income subsidy, have a special enrollment period."

The help line for the program is 800-443-9354. The number for Medicare is 800-MEDICARE.

rcraver@wsjournal.com -- 727-7376

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Affected beneficiaries

Nearly 3,800 Medicare beneficiaries in the Triad and Northwest North Carolina are affected by the suspension of Fox Insurance Co.

County -- Enrolled

Alamance -- 297

Alleghany -- 57

Ashe -- 111

Davidson -- 344

Davie -- 65

Forsyth -- 658

Guilford -- 851

Randolph -- 311

Rockingham 301

Stokes -- 89

Surry -- 238

Watauga -- 90

Wilkes -- 257

Yadkin -- 97

Source: N.C. Insurance Department.

Newstex ID: KRTB-0222-42636066