. .

BENEFIOIARY SATISFACTION WITH


GEOaGIA' MEDICARE CARRII;R


1:$ 

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OFFICE OF INSPECTOR GENERAL 

OFFICE OF 
 EVALUATION AND INSPECTIONS .


FEBRUARY 1990 
OFFICE OF 
 INSPECTOR ' GENERAL 

The mission of the Offce of Inspector Genera (OIG) is to promote the effciency, effectiveness,. and integrty of progrs in the United States Deparent of Health and Human Services (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 Congress fully and cUrently informed about programs or management problems and recottends 

. corrctive action. The OIG perform its mission By conducting audits, investigations, and inspections 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 program effectiveness, effciency, and vulnerabilties to fraud or abuse. 

The purose of this inspection, entitled "Beneficiar Satisfaction with Georgia s Medcare Carrier " 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 

major changes in the Medicar Par B progr 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 resultig increase in payment denials and reductions caused concern among 

beneficiares and physicians. 

The Inspector Genera of the Deparment of Health and Human Services was asked by the 

Acting Admistrator of HCFA to assess beneficiary satisfaction with Aetna s service over the

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 

claims processing which ar 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. 

Seventy-the 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


Satisfaction with the Appeal Process Cannot Be Determined 


Respondents' Comments Were Generally Positive 


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


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


APPENDICES


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


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


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

INTRODUCTION


PURPOSE 

The purose of this inspection, entitled "Beneficiar Satisfaction with Georgia s Medicare Carrier " was to determne beneficiar satisfaction with services provided by the Medicare Par B 

carer in Georgia. Responses were compared to a 1989 Offce of Inspector General (OIG) national "Surey of Medicar Beneficiar Satisfaction" to determne if there were significant differences. 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 certain 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 

known as beneficiaries. Over 680,000 beneficiares reside in Georgia.

The Medicare Program has two pars. Par A (hospita insurance) helps pay for inpatient hospital 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 insurance) 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 

Medicare progr. However, other organizations share in the progr s administration. The 

Social Security Admnistrtion (SSA) establishes eligibilty, enrolls beneficiares in the program, and collects the premiums for Par B coverage. Prvate health insurance companies contract with the Federa Government to service claims for Medicar payment. Insurance 

companies that handle Par A claims ar called intermediaries. Those handling Par B claims

are called carriers. In Georgia, the intermediar is Blue Cross/Blue Shield. The carer is 

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, parcularly in the Atlanta newspapers. Severa of the arcles suggested the changes have caused serious 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 radomly 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 questionnais 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 differences in the wording of the questions, and some questions from the national survey were 

asked only of beneficiares who fie their own claims. Other questions are unique to the Georgia 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 differences in the two sureys and a detaled comparson of responses. 
FINDINGS


This surey found that Georgia Medicare beneficiares hold opinions of Medicar and carer 

claims processing which ar 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 beneficiaries. They were asked about their experience and satisfaction with varous aspects of the Medicare 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 national surey, although Georgia beneficiares appear to be slightly more negative about contacts 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 processed Medicare claims they or their doctors submitted in 1989. Eighty-eight percent of beneficiares nationwide ar 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 ' satisfaction 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 nationwide) 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 Georgia beneficiares stated fuer: 

! 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 problems. About 40 percent said they experienced a problem with the amount Aetna paid. A similar 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 denied. 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. However, only those beneficiares who submit their own clais were asked. (See appendix C for information 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 mistakes or just perceived as mistakes. . 
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 

of Georgia and national respondents think the program is understandable. 

said they can get information about the Medicare program 


About hal of the Georgia respondents (51 percent) indicated they had needed specifc information 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 representatives. 

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 

about a clai. Almost three-fours (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 problems, 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. Onethird 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 answering 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 tollfree number to cal their carers. Eighty percent indicated they had been satisfied with the serVIce. 

The national questionnaie listed 5 of the previously mentioned problems beneficiares could 

encounter when calling their carers. The incidence of problems cited by beneficiares nationwide 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 beneficiaries said they had a problem with the amount Aetna had paid on their claims, only 34 beneficiares 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 comments about the Medicar program. Almost hal (44 percent) chose to do so. Forty-one percent 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 unrelated to the Medicar program. 
HCFA COMMENTS 

The HCFA reviewed a preliminar draft of this report. In response to HCFA's technical questions (see appendi E) we clarfied our explanation of the study methods. One of HCFA' 

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 simple random sample of that universe was selected. 

Based upon previous experience with mail sureys of Social Securty and Medicare beneficiaries, 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 employed 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 questionnaies were undeliverable, 32 beneficiares were deceased, and 10 individuals were erroneously selected. This reduced the sample size from 637 to 590.


A tota of 491 beneficiares ultiately responded to the surey. This represents a response rate 

of 83.2 percent, and produces estimates within 9 percent of the tre value at the 95 percent 

confidence level. 

A ­

APPENDIX 8


RESPONSES TO GEORGIA MEDICARE BENEFICIARY SURVEY 

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 

NO ANSWER 

102 

347 

Gettng informtion on the 

statu of your claim(s) 

YES 

NO ANSWER 

339 

The amount MedicarelAetna 

approves for payment 

YES 

NO ANSWER 

198 

250 

Understanding what Medicarel 

Aetna paid on your claim and why 

YES 

NO ANSWER 

178 

260 

MedicarelAetna denying your claim 

YES 

NO ANSWER 

355 

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? 

MOST OF TH 

SOME OF TH 

SELDOM OR NEVER 

I HAVE NEVER NEEDED TO GET 

INORMATION 

NO ANSWER 

151 

204 

Where did you go first to get information about your Medicare claim(s)? 

MEDICARE/AETNA 

SOCIAL SECUR 

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 responses. 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 

COMPARISON TO 1989 NATIONAL SURVEY

In June 1989, the HHS Inspector Genera conducted a national surey of Medicare beneficiaries. The sample for the surey was drawn from HCFA's Par B Medicar Annual Data System 

ftes. All respondents had received Par B Medicar services in Calendar Year 1987. The Part 

B clais had been fied by either the beneficiares or their doctors. That surey asked beneficiares about their experience and satisfaction with varous aspects of the Medicare program 

includig clais processing. 

Diferences between the Surveys


The surey of Georgia beneficiares included some questions which exactly matched those 

used in the national surey, and some questions which were similar to those used in the national 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 

asked of all beneficiares (including those whose doctors fied clais for them) on the Georgia 

surey. 

Secondly, questions #3 and #9 on the Georgia survey (concerning problems with claims processing 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 

In general, do you think: 

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 

Put II on hold" too long 

YES 

Answers given were not 

understandable 

YES 

Ansers given were not correct 

YES 

Person ansering phone was 

not very courteous 

YES 

70% 71% 

31% 29% 

56% 60% 

44% 40% 

34% 25% 

66% 76% 

16% 12% 

84% 88% 

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


ANAL YSIS OF RESPONDENTS VS. NONRESPONDENTS

Bias may be introduced in sureys of this type if the nonrespondents ar dierent from the respondents. This surey s high response rate (83 percent) diminishes the potential for nonresponse 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 nonrespondents. 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. 

Responses to the questions were analyzed to determine whether a corrlation exists between 

respondent characteristics and opinions of Medicar. The thee questions relate to the Medicare program in genera, informtional services, and Aetna s claims processing. These questions 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: 

Q- l.
 Is Medicare understandable?

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 average 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. Response rates were virually the same for men (84 percent) and women (83 percent). Comparing 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 percent 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 responses, 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 respondents. 

survey, the 369 responses received within 2 weeks 

(75 percent) were compared to the 122 received the following 4 weeks (25 percent). No statisticaly signifcant difference existed between the early and late responses. 

To test for possible nooresponse bias in this 

1 Offce of Inspetor Genera, United States Deparent of Health and Human Services. Social Security Client 

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 

..,,)O 

Date 

From 

Subject 

Memorandum 

FEB - 8 1990 

Director 

Bureau of Program Operations 

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 

level of Georgia beneficiaries after their firt year of service from Aetna. In 

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