Former Knoxville nursing assistant avoids insurance scam

Investigations

KNOXVILLE, Tenn. (WATE) — Laurie Clark has heart disease and underwent open-heart by-pass surgery 21 years ago. With other medical complications, the former certified nurse’s assistant is disabled and lives on a fixed income of about $800 a month.

Her health insurance is covered by Medicare, Medicaid and TennCare. She’s a member of Amerigroup, a managed health care provider, set up for people with disabilities like Laurie.

“I have never ever received a call from my insurance company wanting me to change my plan,” Clark said.

She’s been mailed flyers about various health plans but beginning last month, she started receiving calls.

“He wanted, basically he wanted to do an open enrollment and combine my Medicare and Medicaid into a single program,” Clark said. “He said, ‘Hello, my name is,’ and he mumbled it.

“And he said, ‘I am with Amerigroup.’ ”

Clark said she was suspicious and the man asked for her Social Security number. She provided no personal information and ended the call.

She then called the 800 number on her Amerigroup card.

“(I) explained what had happened, that I had received a phone call claiming they were with Amerigroup,” she said to her health care provider. “He said that was not a valid Amerigroup number.”

She then called Medicaid to report what happened.

Under federal rules, insurers cannot call you. Choosing a health plan during open enrollment is up to the individual. It is your choice which plan you want.

You can shop for individual health plans in several ways. The federal marketplace at healthcare.gov and state exchanges are options. You can also call a local insurance broker for more information.

Advertisements can be sent in the mail but solicitation over the phone is prohibited.

The period to enroll under the Affordable Care Act was extended Monday to 3 a.m. EST Wednesday, Dec. 18, 2019. The yearly enrollment period comes with lots of rules for those who seek insurance and insurers.

Three of Tennessee’s five insurance carriers have expanded their coverage areas for 2020, according to the Tennessee Department of Commerce and Insurance.

Carriers and coverage areas on the individual market are as follows:

  • BlueCross BlueShield of Tennessee. Statewide coverage includes adding the Memphis and Nashville areas.
  • Bright Health. Continuing coverage in Knoxville, Memphis and Nashville areas.
  • Celtic/Ambetter Insurance. Coverage expansion into Nashville and Knoxville areas with continuing coverage in Chattanooga and Memphis areas.
  • Cigna. Coverage expansion into Chattanooga and Jackson with continuing coverage in Knoxville, Nashville, Memphis, and Tri-Cities.
  • Oscar Health. Coverage continues in Nashville and Memphis.

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