Column: A telemarketer. An Alzheimer’s patient. A health insurance nightmare
Every time you think you’ve seen every possible way the U.S. healthcare system lets people down, along comes some new outrage that leaves you slack-jawed and shaking your head.
This is one of those.
Linda Williamson’s 76-year-old mother has Alzheimer’s disease. She still lives in her San Fernando Valley home with the help of a caregiver. Williamson has two notarized power-of-attorney documents to handle her mom’s finances and healthcare.
“She can’t drive,” the Granada Hills resident told me. “She can’t do her own shopping. She doesn’t pay her own bills. She doesn’t always remember the names of her grandkids.”
So just imagine what might happen if an aggressive salesman got on the phone with her to pitch a change in health insurance providers.
And imagine what might happen if a major health insurer didn’t want to listen to reason after signing her up as a new customer.
I could stop right here, since you probably already see where this is going and what a nightmare this represents for all people with aging parents.
But let’s continue. It’s important to spell out, as often as necessary, how reckless our healthcare system is and how, time after time, it places profits ahead of patients.
Williamson, 52, said she didn’t learn of the situation until she visited her mom’s house the other day. She found paperwork from the insurance company Humana welcoming a new member into the fold.
She also found a letter from Anthem Blue Cross saying it was sorry that Williamson’s mom is no longer a Medicare Advantage customer. The Anthem coverage was connected to Williamson’s mom being employed in the past by the Los Angeles Unified School District.
“The Humana plan was a worse deal,” Williamson said. “My mother would have to pay more out of pocket.”
That’s probably not what the salesman told Williamson’s mom. He was with a Santa Clara company called EHealth, which bills itself as a “marketplace” for health insurance plans, many targeting older people with Medicare eligibility.
“We do it for a simple purpose — to protect your well-being for life,” the company’s website declares.
EHealth acknowledged in a 2019 regulatory filing that telemarketing is a key part of its business. “We have in the past and may in the future become subject to claims that we have violated” the Telephone Consumer Protection Act, it admitted.
That law, enacted in 1991, is intended to protect consumers from aggressive, unfair or abusive telemarketers.
Piecing things together, Williamson figured out that her mom either called or received a call from an EHealth salesman, who talked her into switching from Anthem to Humana. EHealth telemarketers receive commissions for the policies they sell.
Williamson immediately contacted Anthem and was instructed to call Humana and cancel the new policy as “never active.” No claims had been submitted, no money was owed.
Williamson did as advised. A Humana service rep, she said, informed her that no changes would be possible before the end of April, which at the time was still several weeks away.
Williamson countered that the Humana policy was unauthorized because she has power of attorney over her mother’s healthcare. The Humana rep demanded to see a copy of the legal document.
“So I sent them the two different powers of attorney, for my mom’s healthcare and finances,” Williamson recalled. “Then they said I needed to send in a signed letter requesting disenrollment. I did that.”
Several days passed. Williamson called Humana again and this time was told her letter hadn’t been signed. She told the rep to call up the document on her computer. Yup, there was her signature.
More time went by. Williamson called again and now was told she didn’t have the right power-of-attorney status to cancel her mom’s coverage.
Williamson pointed to a provision in one of the documents where it explicitly authorizes her to make insurance decisions on her mother’s behalf.
“So then, after numerous calls and transferring me all over the company, they asked me to put my mom on the phone,” Williamson said. “I told them I won’t do that. It would just confuse her and stress her out.”
Humana insisted there was nothing more they could do. So Williamson came knocking at my door.
“I think they’re deliberately dragging their feet,” she said. “I think they want at least one or two months’ premiums before they do anything.”
Over the years, I’ve written about nearly every possible way health insurers can screw people over, from refusing to cover medically necessary treatments to being complicit in ridiculous medical bills.
But this is pretty extraordinary: A health insurer using a commission-driven third party to sell coverage, not acknowledging the validity of requested legal documents, throwing repeated roadblocks in the way of resolving the problem.
And then there’s the Alzheimer’s aspect. You’d think this would have immediately escalated the matter to a high enough level within Humana’s corporate hierarchy to remedy things. Instead, the company acted like none of this was its problem.
I reached out to all the businesses involved.
Lara Sasken, an EHealth spokeswoman, said her company “does not make cold calls for the purpose of enrolling people in Medicare plans,” suggesting it may have been Williamson’s mom who initiated the process. (Williamson says her mom receives direct mail all the time encouraging changes in Medicare Advantage coverage.)
“Our agents are trained to be aware of potential beneficiary impairments and other factors that could impact decision-making,” Sasken said. “We also ask if the beneficiary has access to a third party who helps with their medical decision-making.”
These steps clearly were insufficient in this case.
Williamson said that while it’s possible her mom called EHealth based on some promotion or ad she saw, it should have been obvious to the salesman that her judgment was impaired.
“Any conversation with her contains lots of gaps,” she told me. “The number of nouns she has at her disposal is greatly diminished, and she simply replaces them all with ‘the thing.’”
Let’s just acknowledge right now that commission-driven telemarketers should have no role in healthcare. What happened to Williamson’s mom makes that plain.
Of the three corporate players involved here, Anthem is the only one that comes out untarnished.
Williamson told me that shortly after I contacted Anthem with details of the matter, a company executive got in touch to acknowledge that the power of attorney over her mother’s healthcare was indeed valid.
Because of that, the Anthem exec told her, the company would restore her mom’s Medicare Advantage coverage and make sure the Humana policy was canceled.
Leslie Porras, an Anthem spokeswoman, declined to address the matter directly.
She said only that “in situations where individuals believe their health coverage was improperly changed, the beneficiary or the person with power of attorney should contact the administrator of the health plan they want to be in and apply to re-enroll.”
Humana, for its part, also contacted Williamson after I got involved to say that it too had determined the power of attorney is valid — after earlier insisting to Williamson it wasn’t — and said it would cancel the new policy.
“At Humana, we strive to help members with their coverage,” said Lisa Dimond, a spokeswoman.
Once the company had been able to determine the legitimacy of Williamson’s notarized power of attorney, she said, “we were able to quickly process a disenrollment, effective April 30, 2021. We’re glad we were able to resolve the issue.”
Williamson told me she’s pleased to have all this settled. But her treatment by Humana left a bitter taste in her mouth.
“Once they realized what was happening, they should have accepted that it was their responsibility to fix things,” she said. “Instead, all they said was, ‘Nope, nope, nope.’”
I asked what this episode taught her about the U.S. healthcare system.
“The profit motives are very naked,” Williamson replied.
Can’t argue with that.