Avoiding a $190M Loss: Why Just One TTY Call Matters
In January, Elevance Health, the fourth largest Medicare Advantage carrier, sued the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services over $190 million in lost Medicare enrollment bonus payments. The company anticipates the ultimate revenue impact could reach $500 million.
The lawsuit resulted in Elevance Health receiving four Medicare Advantage contracts with higher 2024 ratings after CMS updated the original scores announced in October, according to a regulatory filing.
Why Sue?
Elevance's star rating was impacted by a single TTY "secret shopper" call during last year's CMS Star Rating testing season — a call they argue never came in.
The original star rating reduction and the subsequent lawsuit were both based on that single missed call from CMS testers, which caused Elevance to fail its required 99% success rate. Elevance states the call dropped through no fault of their own.
In the lawsuit, Elevance argued that the Tukey method was used as an "unlawful, and arbitrary and capricious" methodology to change star ratings. The insurer contended that the Tukey method does not account for the 5% guardrail for cut points, and therefore CMS violated the guardrail regulation when deciding 2024 star ratings. The lawsuit also argues that meeting the stated 99% success rate would have been mathematically impossible without 100% call completion — not a single miss.
Notable Impacts
Elevance was able to sue HHS and receive new, improved ratings. The case raises important questions: do other providers have evidence to support the same argument? And how will the industry evaluate TTY service providers and call records now that Elevance has put a real dollar figure on what a star reduction actually costs?
Elevance uses the federally funded — and free — 711 text telephone service. CMS's view, as relayed by NexTalk clients, is that if you use 711, you're on your own. Because providers don't have access to 711 call data, there is no way to dispute a failed test result. Elevance got lucky this time due to a statistical calculation argument, but the question remains: would CMS expect more concrete evidence next time?
The Right Solution
With NexTalk, providers have access to complete call data and the documentation needed to rebut scoring issues — without going to court. Providers who put their fate in a government-funded 711 service are choosing to save thousands while risking millions.
Real-Life Case
A NexTalk customer — the largest non-profit health insurer in New York — faced this exact scenario: a disputed CMS test call failure. By providing complete call data from NexTalk's system and its carriers, the insurer proved the failed call never happened. CMS overturned the lower score, raising their aggregate rating above the critical 4-Star threshold.
In their own words, this meant tens of millions of dollars — and no court date.
For insurers who prioritize quality control, who rely on data to back up a claim, and who seek to provide a better experience for an often underserved community: remember that free isn't always free. When it comes to TTY, NexTalk is here to help.