Recent Lawsuits Spotlight Call Center Performance

How much does call center performance influence Star Ratings for a Medicare Advantage plan? Consider the recent news about four insurers that stood to lose huge amounts of bonus payments — $1.4 billion in one instance— due to lower Star Ratings related to their call centers.

Specifically, CMS alleged instances of failure to meet service criteria for “secret shopper” calls involving foreign language interpreters or TTY (message relay center for individuals with impaired hearing). All four insurers disputed the CMS findings and sued to recoup their bonus payments.

Regardless of how these cases were, or are in the process of being, resolved, one thing is clear: CMS places a high priority on timely, problem-free call center interactions with health plan members. Moreover, in its calculation of Star Ratings, CMS examines many facets of a call center’s performance — right down to seemingly minor details.

This scrutiny exposes the potential vulnerabilities of call center operations, along with the major financial repercussions for health plans, whether it’s the loss of bonus payments or an erosion of membership due to negative publicity.

The lawsuits against CMS reveal details that should cause health plan leaders to examine their third-party benefit administrators’ call centers — which must meet the same requirements as health plan call centers. This includes:

• TTY calls — Call centers must answer 80% of incoming calls within 30 seconds, provide TTY service within seven minutes of call initiation, limit average hold time to no longer than two minutes, and limit the disconnect rate of incoming calls to no more than 5%.
• Language interpreter calls — For non-English-speaking and limited English-proficient (LEP) individuals, call centers must provide interpreters for 80% of all calls within eight minutes of reaching the customer service representative.

How does Amplifon Hearing Health Care, a third-party administrator of hearing benefits, measure up to these requirements?

The Amplifon call center consistently exceeds CMS requirements, reflecting our commitment to exceptional service. Year-to-date metrics through October 2024 reflect this performance: We answered 86% of incoming calls in less than 30 seconds, the average caller wait time was just 16 seconds, and the call abandonment rate remained low at 2.25%.

These metrics include TTY and language interpreter calls — which is no accident, given our intensive focus on both areas. For TTY calls, we use a nationwide telecommunications relay service (TRS) that complies with CMS requirements and is available to consumers at no charge.  To accommodate non-English-speaking and LEP callers, our call center team includes several individuals who speak Spanish, our most commonly requested foreign language, and we contract with a vendor to provide interpretation for other languages, all within the CMS timeframe.