Robert King writes for Politico about the Republican and Democratic anger directed at insurance companies for denying care inappropriately to older adults and people with disabilities enrolled in Medicare Advantage plans. Complaints to members of Congress from people enrolled in Medicare Advantage, as well as from health care providers treating people enrolled in Medicare Advantage, are on the rise. And, for good reason.
Now, more than half the Medicare population is enrolled in a Medicare Advantage plan, a health plan administered by a corporate health insurer. Whether people have been steered to a Medicare Advantage plan by a friend, an employer, a union or Joe Namath, no one likely told them that they were putting their health and well-being at risk. No one likely told them that insurers offering Medicare Advantage plans can and do too often deny or delay critical care with impunity, as a way to maximize profits.
Most people don’t appreciate that the government cannot ensure that Medicare Advantage plans cover their care. And, the Centers for Medicare and Medicaid Services, which oversees Medicare Advantage, is hard-pressed to warn people about the Medicare Advantage bad actors, let alone cancel their contracts.
Senator Ron Wyden, Chair of the Senate Finance Committee, recently held a hearing focused on the misleading marketing in Medicare Advantage. His takeaway: “It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care.” What’s truly stunning is that corporate health insurers offering Medicare Advantage plans have been denying care inappropriately for years, and it’s only now that Congress is waking up to this horror show, which is literally leading to tens of thousands of unnecessary deaths each year, according to one academic study.
Corporate health insurers use prior authorization tools, which require insurer approval in order to ensure coverage, as a way to delay urgent care as well as to deny it. Insurers also use artificial intelligence or AI to make sweeping acr0ss-the-board denials of care, without regard to particular patient conditions, in violation of their Medicare contracts. Stat News recently reported on the grave harm to patients entitled to rehabilitation services when enrolled in some Medicare Advantage plans.
Here’s more from Just Care:
- UnitedHealth deprives members of critical rehabilitation care
- Corporate health insurers use NaviHealth algorithms to deny care in Medicare Advantage plans
- Well-kept secrets of Medicare Advantage plans
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- OIG finds widespread inappropriate care denials in Medicare Advantage
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