SelectCare of Texas TexanPlus Universal American - TexanPlus looks good on paper but there is very poor customer service, representatives are poorly trained and unprofessional, and providers complain as well that TexanPlus makes it difficult for services to be approved

Posted on Wednesday, February 11th, 2009 at 10:03pm CST by 22e8901d

Product: Medicare Advantage Plan

Company: SelectCare of Texas TexanPlus Universal American

Location: 4888 Loop Central Drive, Suite 700
Houston, Te, 77081, US

URL: http://www.universalamerican.com or www.sctexas.com/

Category: Other

Texan Plus looks great on paper but when it actually comes to providing quality service, it fails on many different levels. The first is lack of access to care and information through their representatives and it is very difficult for both providers and consumers. Requests for service for medications or procedures have been held up by Texan Plus initially denying it and then not notifiying the consumer about it or lengthy delays in responding by mail to finally tell you. When providers call in or consumers, one is placed on lengthy hold times, and then when one does get through the representatives are uninformed, misinformed, and even when they tell you they will take care of it, such as requesting a provider book or drug book, they do not send it. When I requested to speak to a supervisor after dealing with an unresponsive representative, he refused to allow me to speak with one and there are no avenues to go higher as they only provide one phone number for customer service and no email address. Second, the representatives are also retaliatory when one does make a complaint. Even if one complains to Medicare, all Medicare requires is a response back from the Advantage Plan to the consumer by phone call and Medicare does no follow up. When one writes a grievance letter to the company, all one receives is a general letter stating they will look into it and never resolves anything. An extremely frustrating experience and one where the consumer has no voice or power.


16 Comments

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0fa670da, 2009-08-14, 12:44PM CDT

It also does not begin to cover chemo and they bury that in the book. My cancer center is cancelling acceptance of Texan Plus so I am in a real bind.

c8092261, 2009-10-22, 03:46PM CDT

Insurance came from word Sure.

Surely Quest way Do not pay.

Support our president for reform and fighting

with banditos any kind.

Eugene.

07c0c0dc, 2009-11-16, 11:30PM CST

I agree totally. I have also experienced the same problems with very poor customer service, and incorrect information regarding providers.

20506186, 2009-11-17, 10:00AM CST

I experienced the complete opposite when it came to a grievance letter. You are right regarding the untrained rep. and I will add, they sometimes misinform. However, after a grievance letter, I have been contacted 3 times. Will anything change? I doubt it, but those who called and wrote me did sound like they cared.

494446a9, 2010-03-19, 09:55AM CDT

I am so surprised that you had a difficult time with Texan Plus. I have been a member for 6 years and have nothing but praise for the plan. I never have problems with referrals, prescriptions or doctors. I would recommend it to everyone. It is affordable and pays for things that Medicare wouldn't even consider paying for. I have saved a lot of money with Texan plus without sacrificing my health!

2c3d8e62, 2010-06-18, 11:01AM CDT

My husband is 60 and has progressive multiple scelrosis. He was denied a handicapp shower to be paid for by texas plus and the doctor is fed up trying to deal with them to get it covered, he gave up the people he tried dealing with were hard to deal with. He is scooter bound, one leg does not even bend and is swollen and almost impossible for me to pick up over the bath ledge. We had to move into this house so he could drive his scooter thru it our other one was too small. This is a financial hardship on us to get a loan when we already had to buy a home we weren't wanting to do but he needed the room. They have no MS drug covered, although they are working with us on that, that has caused him to be off his medicine for a very long period of time while waiting, he is very weak.

One fall trying to get him into the shower would cause this insurance so much more than it would to gert it put in, we found a very low bid. I am so upset we choose this insurance, they do not help the elderly. This are the most coslt people if not taken care of, what is up with that?????

e7cf4343, 2010-10-27, 10:11AM CDT

Texan plus is a nightmare, I am a provider for them and they provide good primary care but when something complex comes up finding a specialist is impossibile. When a specialist is found they get lazy and do not want to operate on Texan plus patients because their pay is so low its not worth the risk so the patient suffers, if you are healthy Texan plus is great but if you fall ill then good luck.

edc269bf, 2010-10-29, 01:34AM CDT

I have had TexanPlus coverage for 3+ years and my experience has only been very positive.Number of Providers is extensive and in my experience very skilled and qualified. A little research on the patients part will help insure finding the best and most appropriate Specialist referrals.When needed, customer service has been polite, knowledgeable and diligent. I have received a surprise QC call shortly after hanging up with Service Rep to check my satisfaction with the Rep and the info received. Even solicited my suggestions for improvement/enhancements. Pretty impressive.

e024f1e3, 2011-01-29, 08:40PM CST

I agree. We are in Hawaii and my husband fell today on a boat and cut a gash in his head. We called the number on our Texan Plus Card and it was absolutely no help at all. We honestly don't know what to do...it's not an emergency worthy of a trip to the hospital but does need attention. The Texan Plus plan is useless if you are away from home.

18bbdd96, 2011-10-04, 01:01PM CDT

I agree I made an appointment 2 weeks in a row. they accept the appointment. Call me back day before and say rhe doctor doesn't take texan Plus after texan plus is the one that said they do. I have yet to get an appointment.

8d2c4825, 2011-10-28, 09:40PM CDT

Universal American, Texan Plus' parent company, has relocated their member service departments. A much needed and wise decision! Now located in the United States, communicating with representatives is much easier. Previously the language barrier set-up more road blocks than a good persons patience could compete with! In regard to the traveling couple from Texas, no matter which insurance company you choose or type of plan you may have, it is imperative to review plan coverage documents. Understanding the benefits your plan provides and their associated cost shares should be a member's first priority. Especially before traveling or scheduling surgery or medical procedures. Texan Plus is a Health Maintenance Organization. HMO means network. HMO plans offer the richest benefits for lower or no premium but in order to receive those rich benefits HMO plan members must stay inside the plans network with the EXCEPTION of EMERGENCY or URGENT CARE SERVICES and out of area dialysis services. If the out of network urgent care a Texan Plus plan member receives was medically necessary, per Texan Plus subscriber agreement (or member policy) the plan must pay. Keep in mind: Emergency or Urgent Care and Routine Care (Primary Physician ie: Internist, General Practice, etc) are NOT one in the same. If you see a Primary Care Physician out of network, no matter the reason, the visit will not be covered. Coding on claims submitted (to insurance plans by providers) dictates a lot. Once again, coding for primary care and urgent care are NOT one in the same.

ca13aa41, 2011-11-11, 11:01AM CST

I totally agree with the above complaint. To the point that we are now, because of the open enrollment period, seeking a new provider.

What started out as a great Company, is now, in the words above, very poorly operated with zero care for the customer

115e9ab1, 2012-01-03, 06:09PM CST

I was a TexanPlus provider specialist for about two years. Services were preauthorized and approved for payment and despite written appeals, legal action was taken in Court to be paid for services rendered. In 2010, this company was suspended by CMS for the way it conducted business. Nothing has changed. My contract just terminated on 12-31-2011 at midnight. The last patient was seen on 12-30-2011 and her prescriptions I sent electronically on 12-30-2011 to her pharmacy were denied by TexanPlus and remain unfilled. Her denied medications included her blood pressure medication. I called TexanPlus today, 1-3-2012, speaking to their Director of Operations and received e-mails that they (TexanPlus and Universal American) will no longer provide provider support because my contract was terminated 12-31-2011. All the services were performed 12-30-2011. TexanPlus is indeed out-of-control. Can we afford to have Medicare Advantage companies like this be responsible for managing patient care? While out-of-network, I called this patient today, 1-3-2011, and she stated she still has been denied her formulary approved medications and the pharmacy is to call her when it is been approved for coverage. TexanPlus today stated that it was being taken care directly with the patient. She has called 1-800-MEDICARE and filed a complaint. If everyone filed a complaint due to this kind of service Medicare will respond and take action again.

d8a3503d, 2012-02-07, 11:39AM CST

Sounds like a company that is bankrupt or headed that way. I have a urinary procedure scheduled in march and then I think we will look else ware for provider.

de169d85, 2012-02-08, 02:42PM CST

I AGREE WITH EVERY THING IN THIS STATEMENT. YOU ARE TREATED VERY POORLY . I DO NOT UNDERSTAND WHY TEXAN PLUS SENDS OUT A PROVIDER BOOK AND THE REPRESENTATIVE CAN'T FIND ANYTHING IN IT. THEY SURE ARE GOOD AT TAKING YOUR MONEY OUT OF SS CHECK THOUGH.THEY ARE ALSO VERY GOOD AT TRANSFERING YOU TO ANOTHER COMPUTER TO TALK TO.

5b5f5eb0, 2012-06-08, 11:00PM CDT

The only reason why you guys has such good luck is because you are healthy. I am a Texan Plus Provider and found that once that patient are sick, that is it. They send note telling us to tell the patient to put their loved ones into a nursing home. This is so they can get rid of them, because then it goes into regular Medicare. Their favorite response, (coming from high up in ranks) is, "their family getting sick, sounds like a social issue to me. Are we responsible for taking care of them?" This was the exact words that was told to me because a husband wanted to get Physical therapy, Occupational therapy and a home health aid to help his wife until she is waling again. She fell, and was afraid to walk (this is sometimes a typical reaction in the elderly).

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