A federal court has ruled that the Centers for Medicare and Medicaid Services does not need to recalculate Humana Inc.’s 3.5 Medicare Advantage Star Rating, finding that the government correctly tabulated the insurer’s rating when it factored in disconnected customer-service test calls, according to BestWire.
The insurer was asking the court to set aside the 3.5 Star Rating and have the CMS recalculate rating.
As part of a call center accuracy and accessibility study, the CMS placed three test calls to Humana, according to the initial complaint filed in U.S. District Court for the Northern District of Texas.
In two of the calls, a disconnection occurred when an interpreter was brought on the line, the complaint said. In the third call, the test caller incorrectly thought they were put on a silent hold when a representative was on the line.
Humana said it did not follow up on the calls because the agency prohibited accepting callbacks for the purpose of the study.
The insurer also contended that the agency didn’t follow its own rules, was opaque with its data and failed to provide logical explanations for the Star-Rating decisions.
Humana also asked the court to rule the no-callback policy unlawful. Under this rule, if a test call is dropped before an interpreter successfully joins and verifies certain information, the insurer cannot call back to complete the survey.
The determination on the silent caller was deemed valid because Humana failed to complete the four steps required for the interpreter test call.
The first two stages require the call and connection to a live customer service representative. Stage three mandates a connection to an interpreter within eight minutes after the CMS caller asks an introductory question and the final stage tests accuracy.
Regarding the two dropped calls, the court said the no-callback policy was lawful because it’s a rational gauge of how well the call center performs.
The order said answering questions in a single call is a hallmark of better service, as it avoids inconveniently timed follow-up calls or the inability to reach someone calling from a private number.
The court found Humana failed to complete the third stage because it hung up on the silent caller after a little more than six minutes.
Further, since the caller could not hear anything, the CMS could not determine if there was a connection to a live representative.
