SummaCare Inc. has been given more time by the federal government to explain its plans to correct problems with its Medicare managed-care plans.
The Centers for Medicare and Medicaid Services granted SummaCare an extension until Sept. 5 to submit its plans to fix how it handles consumer appeals and grievances, a spokeswoman said on Thursday.
CMS last week suspended all new enrollment and marketing for SummaCare’s Medicare managed-care plans because of “multiple, serious violations.”
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,” Summa Health System spokesman Mike Bernstein said. “We remain deeply committed to our members and we pledge to continue working to ensure that all issues are resolved appropriately and as quickly as possible.”
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 Medicare operations in June. SummaCare is Summit County’s largest Medicare managed-care plan, with about 16,500 enrollees from Summit County and more than 33,000 in 41 counties in the northern half of Ohio.
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.
Cheryl Powell can be reached at 330-996-3902 or cpowell@thebeaconjournal.com. Follow Powell on Twitter at twitter.com/CherylPowellABJ.
