. .
. ..
BENEFIOIARY 
SATISFACTION  WITH

GEOaGIA' 
MEDICARE CARRII;R

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OFFICE OF INSPECTOR GENERAL 
EVALUATION AND INSPECTIONS .

OFFICE OF 

FEBRUARY 1990  INSPECTOR ' GENERAL 
OFFICE OF 

The mission of the Offce of Inspector Genera (OIG) is to promote the effciency, effective
progrs 
ness,. and integrty of  in the United States Deparent of Health and Human Ser
vices (HS). It does this by developing methods to 
detet and prevent fraud, waste, and 
abuse. Create by statute in 1976, the Inspector General keeps both the 
Secreta and the Con
gress fully and cUrently informed about programs or management problems and recottends 
. corrctive action. The OIG perform its 
mission By conducting audits, investigations, and in
spections with approximately 1,400 sta strategically located around the countr. 
. OFFICE OF EVALUATION AND INSPECTIONS 
This report is produced by the Offce 
of Evaluation and Inspections (OE!), one of the thee 
major offces withintheOIG. The other two are the Offce of Audit Services and the Offce of 
Investigations. Inspections ar conducte in accordance with professionalstandadsdevel
oped by OEITheseinspections are typicaly short-termsmdies designed to determne pro
gram effectiveness, effciency, and vulnerabilties to fraud or abuse. 
The purose of this inspection, entitled "Beneficiar Satisfaction with Georgia s Medcare Car
rier " was to determne beneficiar satisfaction with services provided by the Medicare Par B 
carer in 
Georgia. Responses were compared to those in a 1989 OIG national "Surey of
Medcare Beneficiar Satisfaction" to determe if there were signicant dierences. 
Th 
pection was performed under the dition of Linda Herzog, the Regional Inspector 
General of Region IV'Offce of Evaluation and Inspections. Pancipatig in the project were: 
Atlanta Region 
Headq uarters 
Betty Davis,  Project Leader  Bar Steeley 
Joe Townsel  Wm. Mark Krshat, MPH 
Maureen Wilce  Vicki Greene 
Peggy Daniel  Barbara Tedesco 
Ar Jones, Ph. 
Joseph. Pattrson 
Jean Dufesne  BENEFICIARY SATISFACTION WITH

GEORGIA' S MEDICARE CARRIER

Richard P. Kusserow 
INSPECTOR GENERAL 
OEI-Q4-90-01050  FEBRUARY 1990
 EXECUTIVE SUMMARY 
PURPOSE 
The purose of ths inspection, entitled "Beneficiar Satisfaction with Georgia s Medicare 
Carer " was to determe beneficiar satisfaction with services provided by the Medicare 
Par B carer in Georgia. Responses were compared to a 1989 Office of Inspector General 
(OIG) national "Survey of Medicar Beneficiar Satisfaction" to determne if there were 
signifcant differences.

BACKGROUND 
On Januar 1, 1989 the Health Care Financing Admnistrtion (HCFA) implemented two 
progr 
major changes in the Medicar Par B  in Georgia: 
The carer was changed from Prdential Insurance Company of America to 
Aetna Life and Casualty. 
The new carer was required to subcontract with a third pary to conduct 
medical reviews of the clais as par of a pilot cost-containment program. 
Aetna chose HealthCar COMPARE Inc. of llinois to review the 
appropriateness of claims and physician charges. 
Beginning in November 1989, both changes have received extensive media attention, 
parcularly in the Atlanta newspapers. Several of the arcles suggested the changes have 
caused serious problems for Medicare beneficiares and the doctors who treat them. 
Aetna s sta-up problems, coupled with a backlog of clais from the previous carer, created 
delays and errors in payments. Furhermore, HealthCare COMPARE devoted more resources 
than Prdential Insurance Company to detecting inappropriate coding and improper utilization 
of services. The  payment denials and reductions caused concern among 
resultig increase in 
beneficiares and physicians. 
The Inspector Genera of the Deparment of Health and Human Services was asked by the 
Acting Admistrator of  satisfaction with Aetna s service over the
HCFA to assess  beneficiary 
first year of its operation in Georgia. The OIG surveyed a randomly selected sample of 
beneficiares for whom Medicare Par B claims were submitted in Calendar Year 1989. 
Parcipation in the surey was voluntar and yielded an overall response rate of 83 percent.  FINDINGS 
This surey found that Georgia Medicare beneficiares hold opinions of Medicar and carer 
ar 
claims processing which  similar to the opinions of beneficiares nationwide. 
Eighty-five percent of Georgia beneficiares are satisfied, in general, with claims 
processing, compared to 88 percent of beneficiares nationwide. 
Eighty-thee percent of Georgia beneficiares can get informtion about the 
Medicare program when needed, compared to 85 percent of beneficiares 
nationwide. 
the 
Seventy- percent of Georgia beneficiares think the carers pay claims 
quickly enough, compard to 74 percent of beneficiares nationwide.  ........................................  
...................................... ........ .............  ............. . ...............  .... ........ .... .... ........ .... ............ ...... ............... .......... ........ .... ................. ......... ...... ....... ........ .. .. .. ........ 
TABLE OF CONTENTS 
EXECUTIVE SUMMARY 
NTRO D U CTIO N  8.........8..8 1

Pu rpose ......................... ............................................ ..................................... D8. 1

Backg ra und. . 
..................................................................................................... 1

Meth ods............................................................................................................. 2

FI N DI NGS. ... ........... ........ .......... ........ .... .... ......  ........... 4

Georgia Beneficiaries Respond Similarly to Beneficiaries Nationwide..... 4

Beneficiaries in Georgia and Nationwide Are Satisfied, in General 
with Claims Processing ...  II 4

Beneficiaries Can Get Information when Needed. 
.............................. 7

Satisfaction with the Appeal Process Cannot Be Determined 

Respondents' Comments Were Generally Positive 

HCF A COMM ENTS ........ ..................... .... 
............ 80.. .... .....11......"II II.. II II ...

APPENDICES

Appendix A: Methods and Sample Selection ................................A -1

Appendix B: Responses to Georgia Medicare Beneficiary Survey..... B -1

Appendix C: Comparison to 1989 National Survey......................... C -1

Appendix D: Analysis of Respondents vs. Nonrespondents ............. D 
- 1

Appendix E: HCFA Comments .................................................................. E -
 INTRODUCTION

PURPOSE 
The purose of this inspection, entitled "Beneficiar Satisfaction with Georgia s Medicare Car
rier " was to determne beneficiar satisfaction with services provided by the Medicare Par B 
carer in  compared to a 1989 Offce of Inspector General (OIG) na
Georgia. Responses were 
tional "Surey of Medicar Beneficiar Satisfaction" to determne if there were significant dif
ferences. The Acting Administrator of the Health Care Financing Admnistrtion (HCFA) 
requested the study. 
BACKGROUND 
Medicare Program 
Medicare is a Federa health insurce program for individuals age 65 and older and for cer
tain categories of disabled people. Authorized in 1965 by title XVIII of the Social Security 
Act, Medicar serves over 33 milion people nationwide. These Medicare recipients are 
Over 680,000 beneficiares reside in Georgia.
known as  beneficiaries. 
The Medicare Program has two pars. Par A (hospita insurance) helps pay for inpatient hospi
tal care, some inpatient care in a skiled nursing facility, skilled home health car, and hospice 
care. A person entitled to Medicare automatically receives this coverage. Par B (medical in
surance) covers physicians ' services, outpatient hospital services, and other medical services 
and supplies. Par B is optional. Beneficiares desirng this coverage pay a monthly premium. 
Both Par A and Par B have deductible and coinsurace requirements. Beneficiares must pay 
these either out of pocket or through supplemental insurance coverage. 
Medicare paid almost $33 bilion for Par B benefits in Calendar Year 1988. Of that amount 
an estimated $692 milion was paid in Georgia. 
Within the Deparent of Health and Human Services (HS), HCFA is responsible for the 
progr. 
Medicare  However, other organizations share in the progr s administration. The 
Social Security Admnistrtion (SSA) establishes eligibilty, enrolls beneficiares in the pro
Par B coverage. Prvate health insurance companies con
gram, and collects the premiums for 
tract with the Federa Government to service claims for Medicar payment. Insurance 
companies that handle Par A claims  Those handling Par B claims
ar called  intermediaries. 
In Georgia, the intermediar is Blue Cross/Blue Shield. The carer is 
are called  carriers. 
Aetna Life and Casualty.  Recent Changes in Georgia 
On Januar 1, 1989 HCFA implemented two major changes in the Medicar Par B program 
Georgia: 
The carer was changed from Prdential Insurance Company of America to Aetna 
Life and Casualty. 
The new carer was requird to subcontrct with a third pary to conduct medical 
reviews of the claims as par of a pilot cost-containment program. Aetna chose 
HealthCar COMPARE Inc. of llinois to review the appropriateness of claims and 
physician charges.

Beginnng in November 1989, both changes have received extensive media attention, parcu
larly in the Atlanta newspapers. Severa of the arcles suggested the changes have caused seri
ous problems for Medicare beneficiares and their doctors. 
Aetna s sta-up problems, coupled with a backlog of clais from the previous carer, created 
delays and errors in payments. Furhermore, HealthCare COMPARE devoted more resources 
than Prdential Insurance Company to detecting inappropriate coding and improper utilization 
of services. The resultig incrase in payment denials and reductions caused concern among 
beneficiares and physicians.

METHODS 
A surey instrment composed of 16 questions was mailed in December 1989 to 637 ra
domly selected Georgia beneficiares who had Medicare claims filed with Aetna in 1989. 
Their parcipation in the survey was voluntar. 
Fort-seven beneficiares were eliminated from the sample for varous reasons: 5 question
nais were undeliverable, 32 beneficiares were deceased, and 10 individuals had been erron

eously selected. This reduced the sample size from 637 to 590. 
A tota of 491 beneficiares returned completed questionnaies, for an overall response rate of 
83 percent. (See appendix A for additional information on methods used in this survey. 
Severa questions in this survey were used in a national OIG inspection, "Survey of Medicare 
Beneficiar Satisfaction" (OAI-04-89-89040), conducted in June 1989. National and Georgia 
surey results were compared for those questions. In some instances, there were slight differ
ences in the wording of the questions, and some questions from the national survey were 
asked only of beneficiares who  own claims. Other questions are unique to the Geor
fie their 
gia survey and were used to address the paricular situation in Georgia. (See appendix B for  responses to all questions in the Georgia survey and appendix C for an explanation of the dif
ferences in the two sureys and a detaled comparson of responses.  FINDINGS

This surey found that Georgia Medicare beneficiares hold opinions of Medicar and carer 
ar 
claims processing which  similar to the opinions of beneficiares nationwide. 
Eighty-five percent of Georgia beneficiares are satisfied, in general, with claims 
processing, compared to 88 percent of beneficiares nationwide. 
Eighty-three percent of Georgia beneficiares can get information about the 
Medicare program when needed, compared to 85 percent of beneficiares 
nationwide. 
Seventy-thre percent of Georgia beneficiares think the carer pays claims quickly 
enough, compard to 74 percent of beneficiares nationwide. 
Georgia Beneficiaries Respond Similarly To Beneficiaries Nationwide. 
In June 1989, the HHS Inspector General conducted a national survey of Medicare beneficiar
ies. They were asked about their experience and satisfaction with varous aspects of the Medi
care program, including claims processing. 
Severa questions used in the national surey were included in the December 1989 survey of 
Georgia beneficiares. Overall, results of the Georgia surey were similar to those of the na
tional surey, although Georgia beneficiares appear to be slightly more negative about con
tacts with their carer. 
Beneficiaries In Georgia And Nationwide Are Satisfied, In General, With Claims 
Processing. 
Eighty-five percent of Georgia beneficiares stated they are satisfied with the way Aetna pro
cessed Medicare claims they or their doctors submitted in 1989. Eighty-eight percent of bene
ar 
ficiares nationwide  satisfied with the way Medicare carers processed claims they 
submitted themselves. (In the national survey, beneficiares were not asked about claims their 
doctors submitted for them. See appendi C for further information regarding the differences 
between the two sureys.

Thiry-nine percent of Georgia beneficiares had seen the recent newspaper aricles about 
Aetna, most of which were critical. Whether these arcles influenced beneficiares' satisfac
tion with Aetna s services could not be established. However, the satisfaction rate of those  who had seen the arcles (72 percent satisfied) was 20 percent lower than those who had not 
(92 percent satisfied). 
Alost thre-fourhs of all the beneficiares (73 percent in Georgia and 74 percent nation
wide) thin the carers pay claims quickly enough. Some Georgia beneficiares mentioned 
that the processing time has improved since the beginning of the year. A couple of the Geor
fuer: 
gia beneficiares stated 
! feel Aetna ma do (as) well as possible since they probably inherited a backlog of 
claims from Prudential. 
! understand Aetna was new at this and needed some time to adjust." 
Although most Georgia beneficiares expressed satisfaction with claims processing, when 
prompted by specific questions 62 percent indicated they had experienced one or more prob
lems. About 40 percent said they experienced a problem with the amount Aetna paid. A sim
ilar proporton said they did not understand the reason why. Almost one-fourth said they had 
had to resubmit their claim(s) or other information. Around one-fifth had trouble fillng out 
the claim form, getting information on the status of their claims, and/or had had a claim de
nied. Figu 1 shows the specific percentages for each problem the questionnai listed.  .........,.............."...........".......-..."............."..............................-..".......................,..............,................."........."........."...................,............."...........,...................."...........".........,............................,............-...........................................................................................-.........-......-......................-...................................................................................................".........."...-......"-......-."........."............"............

Figure 1

GEORGIA BENEFICIARIES REPORT CLAIMS PROCESSING PROBLEMS 
PERCENT 
100 
44% 
Disagreeing  Understading  Resubmittng  Gettng Claims  Having Claims  Filing out 
with Amount  Amount Paid  Information  Information  Denied  Claims 
The national surey asked respondents about three of six problems mentioned above. How
ever, only those beneficiares who submit their own clais were asked. (See appendix C for in
formation regarding the differences in the two surveys. 
The national survey found that: 
Fifty-one percent had a problem understanding what Medicare had paid and why. 
Thiry-six percent had difficulty getting information on the status of their c1aim(s). 
Twenty-six percent had trouble fillng out the claim form. 
Thireen percent of the Georgia beneficiares thought Aetna had made a mistake on their 
claims. This surey could not determine if the actions beneficiares cited were actually mis
as mistakes. . 
takes or just  perceived  Beneficiaries In Georgia And Nationwide Can Get Information When Needed. 
Eighty-thee percent of the Georgia respondents and 85 percent of the national respondents 
when they need it. Thee-fourths 
said they can get information  about the Medicare program 

of Georgia and national respondents think the program is understandable. 
About hal of the Georgia  infor
respondents (51 percent) indicated they had needed  specifc 
mation about their own Medicare claims. Of that 51 percent, 62 percent received the needed 
information most of the time. 
Beneficiares who had received information on their claims were asked where they fist sought 
help. As shown in Figue 2, over a third contacted Aetna. Most of the others sought help 
from their doctors or SSA. A small number contacted other sources such as insurce repre
sentatives. 
Figure 2

BENEFICIARIES SEEK CLAIMS INFORMATION

FROM VARIOUS SOURCES

THEIR DOCTORS 
31%  Only 24 Georgia respondents said they had seldom or never been able to get information 
needed about their claims. Seven of the 24 indicated they had never contacted Aetna for the 
assistace they needed.

Less than one-third (30 percent) of the Georgia beneficiares indicated they had called Aetna 
fours 
about a clai. Almost three- (71 percent) of those who called were satisfied with the 
services they received. 
Durg the period covered by the surey (1989), Aetna acknowledged several star-up prob
lems, among them the operation of the toll-free phone service. This problem was exacerbated 
when the Atlanta newspapers publicized the number in a series of arcles critical of Aetna 
performance. In order to accommodate the increase in calls which these aricles generated, 
Aetna temporaly instaled a second toll-free number. This improved accessibilty, but did 
not solve several other problems, such as unclear explanations of what is paid on a claim and 
why. 
The Georgia questionnai listed possible problems beneficiares could have encountered on 
caling their carer to get information on a claim. Seventy percent of the beneficiares cited a 
busy phone line as an obstacle. Over half thought they were put "on hold" too long. One-
third did not understad the answers given by Aetna, and slightly less than a third did not get 
their question(s) answered. Almost one-fourh of the beneficiares thought the person answer
ing the phone had not been very coureous. Sixteen percent thought the carer s answers 
were not correct. Figure 3 shows the exact percentages.  ..............................................................................-..................................................................................................................................".....,......"..........".........".......'............,.................,............"..............."..............."..........-...,............-.......,...........,...........".....................".............,..........-.,..


Figure 3

GEORGIA BENEFICIARIES EXPERIENCE PROBLEMS CALLING CARRIER 
PERCENT 
100 
70% 
...............................................-..-...-.'OW""'.'.

Line Busy  On Hold  Answer Not  Question Not  Spokesperson  Answer 
Too Long  Understadable  Answered  Not Courteous  Not Correc 
In the national survey, just over one-fourh (28 percent) of the beneficiares had used the toll-
free number to cal their carers. Eighty percent indicated they had been satisfied with the ser-
VIce. 
The national questionnaie listed 5 of the previously mentioned problems beneficiares could 
encounter when calling their carers. The incidence of problems cited by beneficiares nation
wide was no different from the Georgia survey. Nationally, beneficiares responded as follows: 
Seventy-one percent found a busy line as a problem. 
Sixty percent thought they had been put "on hold" too long. 
Twenty-five percent did not understand the answers given by the carers. 
Nineteen percent thought the person they talked to had not been very courteous. 
Twelve percent thought the answers they were given had not been correct.  Satisfaction With The Appeal Process Cannot Be Detennined. 
Over the-fours of the beneficiares in both sureys ar awar they can appeal decisions 
made on their claims. Although in a previous question almost hal of the Georgia beneficiar
ies said they had a problem with the amount Aetna had paid on their claims, only 34 benefici
ares indicated they had appealed Aetna s decisions. Of the 34, only 25 answered questions 
about their experiences with appeals, too few to permt statistical analysis. 
Respondents' Comments Were Generally Positive. 
Respondents to the Georgia surey were offered the opportunity to volunteer further com
ments about the Medicar program. Almost hal (44 percent) chose to do so. Forty-one per
cent of the beneficiares who commented were positive, and 33 percent were negative. The 
positive comments expressed satisfaction with the services provided by Aetna. The negative 
comments focused on delays in payments, low payments, uncovered or disallowed services, 
and diffculty in understading Aetna s explanations. Nine percent of the beneficiares made 
comments that were both positive and negative. Seventeen percent commented on issues unre
lated to the Medicar program.  HCFA COMMENTS 
The HCFA reviewed a preliminar draft of this report. In response to HCFA's technical ques
appendi E) we clarfied our explanation of the study methods. One of HCFA' 
tions (see 
questions concerned the difference in the samples for the Georgia and the national sureys. 
The universe for both samples was beneficiares who had received Medicar Par B services. 
Appendix C explains the diferences in the two surveys.  APPENDIX A 
METHODS AND SAMPLE SELECTION

The purose of this surey was to determne beneficiar satisfaction with services provided by 
the Georgia Medicare Par B carer, Aetna Life and Casualty. The survey universe is 338,857 
individuals who received Medicare Par B benefits in Calendar Year 1989. A nonsttatified sim
ple random sample of that universe was selected. 
Based upon previous experience with mail sureys of Social Securty and Medicare beneficiar
ies, the sample size was calculated to produce an estimate within 10 percent of the tre value 
at the 95 percent confidence level. To arve at the sample size, standard equations were em
ployed for estiting sample size with a binar response varable. 
With an expectation of 65 percent response, a sample of 640 Health Insurance Claim (HC) 
numbers was drwn from HCFA's Par B Medicare Automated Data Retreval System fies for 
Georgia. The names and addresses in that fIe were used for the mai-out. 
Three individuals were removed from the sample because they had out-of-State addresses. 
The 637 questionnaies were mailed December 11 , 1989. Within 2 weeks, 387 responses had 
been received. A second mailng to the 250 nonrespondents was sent on December 26. Phone 
calls were made the week of Januar 8, 1990 to all nonrespondents for whom numbers could 
be obtaed. 
Fort-seven beneficiares were elimiated from the sample for varous reasons: 5 question
naies were undeliverable, 32 beneficiares were deceased, and 10 individuals were erron
eously selected. This reduced the sample size from 637 to 590.

the surey. This represents a response rate 
A tota of 491 beneficiares ultiately responded to 
of 83.2 percent, and produces estimates within 9 percent of the tre value at the 95 percent 
confidence level. 
A 
 APPENDIX 8

GEORGIA MEDICARE BENEFICIARY SURVEY 
RESPONSES  TO 
Number of 
Question  Responses  Percentage 
In general, do you think: 
The Medicare Program is 
understandable 
YES  350

119

NO ANSWER

You can get information about

Medicare when you need it

YES  379 
NO ANSWER 
Medicare/Aetna pays your claims

quickly enough

YES  337

123

NO ANSWER

Thinking about Medicare claims you or your doctor have submitted this 
year, how satisfied are you with way Medicare! Aetna has processed 
those claims? 
VERY SATISFID  150 
GENERALY SATISFIED  227 
GENERALY DISSATISFIED 
VERY DISSATISFIED 
NO ANSWER  Number of 
Question  Responses  Percentage 
The following are possible reasons why someone might be disstisfied 
with Medicare claims. Have any of the following been a problem for you? 
Filing out Medicare claims 
YES 
373 
NO ANSWER 
Having to resubmit claim(s) 
or other information 
YES  102 
347 
NO ANSWER 
Gettng informtion on the 
statu of your claim(s) 
YES 
339 
NO ANSWER 
The amount MedicarelAetna 
approves for payment 
YES  198 
250 
NO ANSWER 
Understanding what Medicarel 
Aetna paid on your claim and why 
YES  178 
260 
NO ANSWER 
MedicarelAetna denying your claim 
YES 
355 
NO ANSWER 
Other (Please explain) 
NUMBER OF PEOPLE RESPONDING  Number of 
Question  Responses  Percentage 
Has Medicare/ Aetna made mistakes on the claims you or your doctor 
have submitted this year? 
YES 
382 
NO ANSWER 
We would like to ask about times when you have needed to get specific 
information about your Medicare claim(s). How often were you able to 
get the information you needed? 
TH 
MOST OF  151 
TH 
SOME OF 
SELDOM OR NEVER 
I HAVE NEVER NEEDED TO GET 
INORMATION  204 
NO ANSWER 
Where did you go first to get information about your Medicare claim(s)? 
MEDICARE/AETNA 
SECUR 
SOCIAL 
YOUR DOCTOR 
OTHR 
I HAVE NEVER NEEDED TO GET 
INORMATION  144 
NO ANSWER 
Have you ever called Medicare/ Aetna to get information about your 
Medicare claim? 
YES  141 
NO (Skip to Q-lO)  325 
NO ANSWER  Number of 
Question  Responses  Percentage 
Thinking about the last time you called Medicare! Aetna, how satisfied 
were you with the service you received? 
VERY SATISFID

GENERAY SATISFID

GENERALY DISSATISFIED

VERY DISSATISFID

NO ANSWER 
B - 4
 Number of 
Question  Responses  Percentage 
Listed below are some possible reasons that someone would be dissatisfied with 
callng Medicare/Aetna. Did you have any of the following problems the last 
time you called? 
Line was bus

YES

NO ANSWER 
Put on "Hold" too long

YES

NO ANSWER 
Not able to get your

question(s) answered

YES

NO ANSWER 
Answers given were not

understandable

YES

NO ANSWER 
Answers given were not correct 
YES

NO ANSWER

Person answering call was

not very courteous

YES

NO ANSWER

Other (Please explain) 
NUMBER OF PEOPLE RESPONDING 
B - Number of 
Question  Responses  Percentage 
10. Sometimes people disagree with the decisions made on their Medicare claims. 
When this happens, you may appeal or request a review of those decisions. 
Did you know before today you could appeal or request review? 
YES  355 
103 
NO ANSWER 
11. In the past year, have you appealed a decision made by Medicare/ Aetna 
on a claim you submitted? 
YES 
NO (Skip to Q-15)  408 
NO ANSWER 
12. What aspect(s) of your claim(s) did you request an appeal on? 
MEICARE/AETNA 
DENID YOUR CLAIM

MEDICARE/AETNA 
DID NOT PAY AS

MUCH AS YOU 
THOUGHT IT SHOULD 
OTHR (Please explain) 
NO ANSWER 
13. How satisfied were you with the appeal proces? 
VERY SATISFIED 
GENERALY SATISFID 
GENERALY DISSATISFIED 
VERY DISSATISFID

NO ANSWER 
B - 6
 Number of 
Question  Responses  Percentage 
14. The following are posible reasons why someone might be dissatisfied 
with the appeal proces. Have any of the following been a problem 
for you? 
Process took too long 
YES 
NO ANSWER 
Disagreed with the final decision 
YES 
NO ANSWER 
Didn t understand the final decision 
YES 
NO ANSWER 
Did not hae an adequate 
opportunity to present 
your argument 
YES 
NO ANSWER 
e. Other (Please explain) 
NUMBER OF PEOPLE RESPONDING 
15. In November there were some articles in Georgia newspapers about 
Aetna s handling of Medicare claims. Did you see any of these articles? 
YES  187 
296 
NO ANSWER 
B 
 Number of 
Question  Responses  Percentage 
16. We are interested in any other comments you may have about your 
experience with Medicare! Aetna. Please provide your comments here: 
POSITIV

NEGATI

MIXD

OTHR

NO ANSWER  273

NOTES: 
Not every respondent answered every question. Percentages are based on actual re
sponses. The number of respondents not answering an individual question is not included 
in the calculation of percentages. 
The sum of the individual percentages may not equal 100 percent due to independent 
roundig. 
B - 8
 APPENDIX C 
NATIONAL SURVEY
COMPARISON  TO 1989 
In June 1989, the HHS Inspector Genera conducted a national surey of Medicare beneficiar
ies. The sample for the surey was drawn from HCFA's Par B Medicar Annual Data System 
had received Par B Medicar services in Calendar Year 1987. The Part 
ftes. All respondents 
B clais had been fied by either the beneficiares or their doctors. That surey asked benefi
ciares about their experience and satisfaction with varous aspects of the Medicare program 
includig clais processing. 
Diferences between the Surveys

those 
The surey of  Georgia  beneficiares included some questions which  exactly matched 
used in the national surey, and some questions which were  similar  to those used in the na
tional surey. 
Two tyes of differences occurrd with the questions that were similar. First, the question 
about satisfaction with claims proessing was asked in the  national  survey only of individuals
who fied their own claims. The satisfaction rate of beneficiares whose doctors fied clais 
for them, therefore,. cannot be determined in the national surey. This question, however, was 
beneficiares (including those whose doctors fied clais for them) on the Georgia 
asked of  all 
surey. 
Secondly, questions #3 and #9 on the Georgia survey (concerning problems with claims pro
cessing and getting information from Aetna) contaned more options than were offered in the 
national surey. 
In summar, because of the difference in the proporton and type of respondent answering the 
questions, and the differences in wording of the questions, it is inappropriate to make direct 
comparsons between the two sureys for these questions. 
How Beneficiaries Responded in Georgia and Nationwide 
The questions asked in both surveys, and the responses, follow: 
C - 1
 QUESTION	 GEORGIA  NATIONAL 
general, do you think: 
In 
The Medicare program

is understandable?

YES	 75%  73% 
25%  28% 
You can get informtion

about Medicare when

you need it?

YES	 83%  85% 
17%  15% 
Medicare pays your claims

quickly enough?

YES	 73%  74% 
27%  26% 
Thinking about Medicare claims you or your doctor have submitted this year, 
how satisfied are you with the way Medicare has processed those claims?* 
VERY SATISFID  34%  26% 
GENERALY SATISFID  51%  62% 
GENERALY DISSATISFID  11% 
VERY DISSATISFID

*In the national surey, only those beneficiares who submit their own claims were asked this 
question.  QUESTION  GEORGIA  NATIONAL 
The following are possible reasons why someone might be dissatisfied with 
Medicare claims. Have any of the following been a problem for you?* 
Filing out Medicare claims 
YES  18%  26% 
82%.  74% 
Getting informtion on the 
status of your claim(s) 
YES  22%  36% 
78%  65% 
Understanding what Medicare 
paid on your claim and why 
YES  41%  51% 
59%  49% 
Thinking about the last time you called Medicare, how satisfied were you with 
the services you received? 
VERY SATISFID  28%  27% 
GENERALY SATISFIED  43%  53% 
GENERALY DISSATISFIED  13%  14% 
VERY DISSATISFID  16% 
*In the national survey, only those beneficiares who submit their own claims were asked this 
question. 
C - 3
 QUESTION  GEORGIA  NATIONAL 
Listed below are possible reasons someone might be disstisfied with callng 
Medicare. Did you have any of the following problems the last time you called? 
Line was bus 
YES  70%  71% 
31%  29% 
Put II on hold" too long 
YES  56%  60% 
44%  40% 
Answers given were not 
understandable 
YES  34%  25% 
66%  76% 
Ansers 
given were not correct 
YES  16%  12% 
84%  88% 
Person ansering phone was 
not very courteous 
YES  23%  19% 
77%  81% 
Sometimes people disagree with the decisions made on their Medicare claims. 
When this happens, you may appeal or request a review of those decisions. 
Did you know before today that you could appeal or request a review? 
YES  78%  76% 
NOTE: 
The sum of the individual percentages may not equal 100 percent due to 
independent rounding.  APPENDIX D

NONRESPONDENTS
ANAL YSIS  OF  RESPONDENTS  VS. 
Bias may be introduced in sureys of this type if the nonrespondents ar dierent from the re
spondents. This surey s high response rate (83 percent) diminishes the potential for non-
response bias. Even so, respondents and nonrespondents were compared demographically to 
assur accurcy of the surey fmdings. 
Method Of Analysis 
Severa data base fies were analyzed to compare the 491 respondents with the 99 non-
respondents. Comparsons were made by age, sex, and race. The same demogrphics were 
used to make comparsons among respondents. The purose of segmenting respondents was 
to review for possible tendencies which could be relevant to nonresponse bias. 
the 
Responses to  questions were analyzed to determine whether a corrlation exists between 
respondent characteristics and opinions of Medicar. The thee questions relate to the Medi
care program in genera, informtional services, and Aetna s claims processing. These ques
tions were asked of everyone surveyed. Responses to the questions were analyzed by 
demogrphics, and early or late receipt of the completed questionnais. 
The questions selected for analysis were: 
Is Medicare understandable?
Q- l.

Can you get informtion when you need it? 
Are claims paid quickly enough? 
Analysis By Age 
Responses of beneficiares age 73 and younger were compard to those of beneficiares age 74 
and older. The analysis by age revealed no statisticaly signifcant diference in responses to 
any of the thre questions. Further, respondents were very similar to nonrespondents. The av
erage ages for respondents and nonrespondents were 72 and 74, respectively. 
Analysis By Gender 
Thiry-five percent of the sample population were males and 65 percent were females. Re
sponse rates were virually the same for men (84 percent) and women (83 percent). Compar
ing male and female responses to the designated questions, there was no statistically 
significant difference between the sexes. 
D  Analysis By Race 
Seventy-eight percent of the sample population was white, 19 percent was black, and 3 per
cent was classified as "other" or "unkown." The rate of response for each racial category 
was very simar to the corresponding frequency in the sample. In comparg the responses to 
the selected questions, the difference among racial groups was statistically insignificant. 
Analysis By Time Of Response 
Some sureys similar to this one indicate that diferences may exist between early and late re
sponses, and furher that late respondents and nonrespondents may share certain tendencies. A 
1989 OIG study of beneficiar satisfaction with Social Securty 1 , for example, suggested that 
the nonrespondents, although not more negative, may be less enthusiastic than the respon
dents. 
survey, the 369 responses received within 2 weeks 
To test for possible nooresponse bias in  this 
(75 percent) were compared to the 122 received the following 4 weeks (25 percent). No statis
between the early and late responses. 
ticaly signifcant difference existed 
1 Offce of Inspetor Genera, United 
States Deparent of  Social Security Client 
Health and Human Services. 
Satisfaction: Fiscal Year  1989. OAI-12-89-00420. August 1989  APPENDIX E

HCFA COMMENTS

E - 1
 ;;'
 "-"-
Health Care 
DEPARTMENT OF HEALTH &. HUMAN SERVICES  Financing Administration 
Memorandum 
..,,)O 
FEB - 8 1990 
Date 
From  Director 
Bureau of Program Operations 
Subject  OIG Draft Report: "Beneficiaries Satisfaction With Georgia's Medicare 
Carrier -INFO RMA TION 
Chief, Health Care Branch 
Office of the Inpector General 
Our comments on the OIG draft report, "Beneficiaries Satisfaction with 
Georgia' s Medicare Carrier" are as follows: 
We believe the report should include an explanation of the difference in 
the criterion used for selecting the surveyed Georgia beneficiaries and 
the one for last year s national survey. As explained during the exit 
conference, beneficiaries surveyed nationally were limited to those who 
had filed their own claims. 
Does the way the sample was derived 
affect the statistics displayed in 
Appendix C, or at least their comparabilty? 
The section entitled, "Analysis by Time of Response , on page D-2, 
refers to "early" and "late" responses. No explanation is provided for the 
differences between "early" and "late . Rather, it appear the 
designation is based strictly on responses falling within either the first 
75 percent or last 25 percent received. 
We believe this survey will be extremely beneficial in indicating the satisfaction 
from Aetna. In 
level of Georgia beneficiaries after their firt year of service 
light of that, I would like to request that OIG conduct a similar beneficiary 
satisfaction survey in New Jersey. As with Aetna Georgia, Pennsylvania Blue 
Shield (New Jersey) has received much criticism from members of the 
New Jersey Congressional Delegation and the physician/supplier community. 
Any questions concerning our comments should be directed to Sue Lathroum on 
X65894. I would alo request that you advise either Sue or me whether OIG wil 
be able to conduct a survey in New Jersey.  C) 
Barbara J. Gagel