ORLANDO, Fla. -- A Florida health insurance company is under fire for selling plans that promise access to all doctors and hospitals after patients are turned away from help, according to a Problem Solvers investigation.
The report featured Paulette and Jim Carollo, who saw an advertisement in the newspaper promoting Universal Health Care's Medicare Advantage plan. The plan promised that people can go to any doctor, anytime, anywhere.
The ad said there was no premium and no deductible for Medicare Part D prescription drug coverage. Also, Universal Health Care promised to pay people back the $93.50 Social Security takes out of paychecks to pay Medicare -- a savings of $1,100 per person, per year, according to the report.
The Carollos said they were surprised when the company would not pay after each had a medical procedure in January.
“And I thought she was going to have a nervous breakdown after she heard that,” Jim Carollo said.
"(The Carollos) are trying to figure out why an insurance company would come to Central Florida to sell health insurance when it appears that few, if any major providers, are part of the plan," Local 6's Steven Cooper said.
The couple was stuck paying more than $2,000 out of pocket -- and they are not alone, the report said.
Thousands of seniors are signing up for the plan, like Sylvia Bathrolemew in Volusia County, who soon found out few, if any providers had even heard of it, the report said.
"Of the doctors you’ve called are any of them accepting this plan?" Cooper said.
"They say they're not going to accept it until they know more," Bathrolemew said.
Local 6 visited a surgeon's office in Orange City where staff had to turn away patients.
"It is hard enough to turn a patient away, it would be nice to have another doctor to refer them to," North Orlando Surgical Group worker Judy Ueltschy said.
"If you get a whole bunch of folks on an insurance plan and you don't have anyone to give them the care then you have done nothing of value to them -- in fact you've done something to their detriment," North Orlando Surgical Group Dr. Jeremy Steinbaum said.
The seniors were sold the plan at seminars where they were fed a free lunch and apparently a lot of hype, Cooper said.
Cooper went to a meeting in Volusia County, Fla.
He said during the meeting, the agent told the crowd that they could go to any doctor or hospital that takes Medicare assignment -- which means providing service for the negotiated Medicare fee.
"So, any provider that accepts that fee scale will accept you." Cooper said. "(But) not so fast. After they’re enrolled, people like the Carollos got a letter which stated they could go to any provider that is willing to give care and accept the plan’s terms of payment."
Cooper asked whether it was any doctor, anytime, anywhere.
"At the seminar, it is not stated that some doctors will not accept this," Cooper said.
"It's in our program, so if we detect that it's not stated, we want to take action on that to ensure that it is stated," COO of Universal Health Care J. Philip Sheesley said.
“So, you are aware that there are patients who have shown up at doctor's offices or hospitals and have been essentially turned away?" Cooper said.
"That's happened," Sheesley said. "Unfortunately, that has happened and we try to avoid that."
The answer is not good enough for state Rep. Scott Randolph, Cooper said.
"I’m going to request that the office of insurance regulation look into this," Randolph said.
Randolph helped the Carollos leave Universal’s plan.
"I think we need to look at these seminars that are taking place across the state," Randolph said. "I think that is something we can regulate."
"If we could save one couple this experience, it's all worthwhile," Carollo said.
Cooper said the plan being sold by Universal Health Care is one of many plans being sold by companies under Medicare Advantage.
"It's called private fee for service -- a program created by Medicare last year," Cooper said. "To call it an "Any, Any, Any" plan is somewhat misleading, since it is always up to the providers to decide who they will do business with."
Cooper said after an investigation, Universal Health Care started cold-calling doctors in Central Florida to try and establish that business relationship.
"Critics said that's something that should be done before selling the plan," Cooper said.
Watch Local 6 News for more on this story.
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