SummaCare given extension to submit plan for Medicare fixes
By Cheryl Powell, The Akron Beacon Journal | |
McClatchy-Tribune Information Services |
The
CMS last week suspended all new enrollment and marketing for SummaCare's
The Akron-based insurer originally was given a Monday deadline to submit its plan to correct the problems.
"We appreciate being granted an extension to allow us time to ensure that we provide a complete response to the concerns raised in the audit,"
In a 10-page letter to the insurer, CMS indicated that the violations "resulted in enrollees experiencing delays or denials and increased out-of-pocket costs for medical services and prescription drugs."
The sanctions resulted from a routine CMS audit of SummaCare's
CMS said the federal action does not affect coverage or benefits for current enrollees. SummaCare, however, is required to notify all enrollees about the sanction.
A total of 38 violations related to coverage determination and appeals were discovered.
Problems ranged from failing to fully investigate consumer grievances to not including adequate reasons in letters denying coverage of prescription drugs.
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