THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, April 21, 1995 TAG: 9504210491
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Medium: 68 lines
The state's decision to transfer control of Hampton Roads Medicaid to private hands has sent insurance companies scrambling to poor neighborhoods to attract customers.
So far, the hands-down winner is Optimum Choice of Rockville, Md. However, Optimum Choice also has generated complaints to state officials for aggressive sales practices.
The complaints include ``cold calling,'' or knocking on residents' doors without an invitation; handing out fliers at neighborhood stores; and asking clients to name relatives and friends as potential clients, state officials said.
Several attempts to reach Optimum Choice executives for comment Thursday were unsuccessful. Optimum Choice is not affiliated with Optima, an HMO owned by Norfolk-based Sentara Health System.
``What we're dealing with is a competitive market,'' said David Austin, a manager with the state Department of Medical Assistance Services, which oversees the program. ``In some cases, there truly are misunderstandings.''
This year, the state began turning over parts of Medicaid to private health maintenance organizations. Medicaid is the federal and state health insurance program for the poor.
Most recipients in Richmond, Northern Virginia and Hampton Roads may choose to enroll in an HMO, which is paid a set amount by the state for each client.
In 1996, Hampton Roads will test a plan to privatize the entire program. All Medicaid recipients here will have to sign up for an HMO.
Four state-approved HMO companies are scrambling for the business, using advertisements, mailings and ``health fairs'' that include a booth with marketing materials.
Optimum has signed up 35,400 people in Hampton Roads, Richmond and Northern Virginia, according to state officials, although they can't say what percentage of that number is in Hampton Roads.
The other three companies, all based in Hampton Roads, have attracted a total of only about 3,400. Optimum is ``by far the most aggressive in marketing,'' Austin said.
Optimum's marketing efforts in Virginia have generated 12 complaints that Austin's department decided were justified. The department follows up on such complaints by contacting the company.
The other three HMO companies have generated just two complaints, though state officials said that might be because they are not signing up as many people.
An Optimum Choice marketer was suspended after a client complained that she had been signed up against her will, state officials said. The signature on the document from Optimum Choice didn't match the client's signature.
In other cases, Optimum Choice marketing representatives have apologized to potential clients after state intervention.
Some of the questionable practices, like the cold calls, violate state guidelines for marketing Medicaid HMOs. Others, like asking a client for referrals to family members, aren't specifically prohibited but aren't good practice, officials said.
Medicaid clients have said they don't like being approached at the market, or having someone knock on their front door uninvited.
``We're trying to do away with practices that really impinge on people,'' Austin said.
Two of Optimum's competitors, Sentara Health System and Priority Health Care, have each generated one complaint. In both cases, the companies had to clarify information in marketing material by adding a footnote. by CNB