Delays, denials, debt and the growing privatization of Medicare

[EvilEyeFleegle]

To all who are thinking about switching from traditional Medicare to Medicare Advantage--DON'T DO IT!

Delays, denials, debt and the growing privatization of Medicare

Medicare Advantage enrollees report treatment denials and delays in payment, leading to harmful outcomes in healthcare

www.theguardian.com

Coffey, 52, had been selling her belongings and raising money on GoFundMe to cover her medical care. To make things cheaper, she shifted her disability plan from traditional Medicare – a government-run health insurance program for older and disabled people – to Medicare Advantage, a program under which private health insurers contract with the Medicare program to provide health benefits.

With monthly premiums of $18.50 per month on average, Medicare Advantage often looks like a frugal alternative. However, private insurers keep premiums low by limiting providers and using byzantine cost containment tools such as prior authorization.
For Coffey, switching proved more expensive, as her Medicare Advantage provider, UnitedHealthcare, denied requests to cover treatments, medications and infusions she required.

Coffey used to be a Republican state representative in New Hampshire. “I changed a lot over these years,” she said. “I used to think we could fix healthcare.”

Her experience with Medicare Advantage is not unusual. Private insurers now cover roughly half of the nation’s 68 million Medicare beneficiaries. Their dominance of this space has grown rapidly over the past two decades – at the expense of patient care, according to healthcare activists and patients, as corporations often deny medical care directed by doctors.

Gary – a retired physicist professor in Connecticut – fought two types of cancer over six years, before passing away in March 2023. He had been put on a Medicare Advantage plan as part of his retirement health coverage, through the University of Connecticut.
Gloria, and Gary’s daughter, Megan, spent the final months and years of his life battling with NaviHealth – his Medicare Advantage plan’s software, through UnitedHealthcare – which constantly denied covering Gary’s medical care and treatment, contrary to doctor recommendations.

Each denial forced them to either cover the costs themselves – such as a wheelchair, for $2,000 – or consistently file appeal after appeal.

“You’re worried about your loved one who is in a medical crisis, you are trying to get there to support them every day, and you’re having to fight these online battles with the health insurance company to try to keep them there,” said Gloria. “It’s just a horrendous additional stress.”
She was informed by both her husband’s doctors, and other experts she contacted for assistance, that the modus operandi of Medicare Advantage private insurers was to deny medical care coverage.

 

[rampart]

To all who are thinking about switching from traditional Medicare to Medicare Advantage--DON'T DO IT!

Delays, denials, debt and the growing privatization of Medicare

Medicare Advantage enrollees report treatment denials and delays in payment, leading to harmful outcomes in healthcare

www.theguardian.com

Coffey, 52, had been selling her belongings and raising money on GoFundMe to cover her medical care. To make things cheaper, she shifted her disability plan from traditional Medicare – a government-run health insurance program for older and disabled people – to Medicare Advantage, a program under which private health insurers contract with the Medicare program to provide health benefits.

With monthly premiums of $18.50 per month on average, Medicare Advantage often looks like a frugal alternative. However, private insurers keep premiums low by limiting providers and using byzantine cost containment tools such as prior authorization.
For Coffey, switching proved more expensive, as her Medicare Advantage provider, UnitedHealthcare, denied requests to cover treatments, medications and infusions she required.

Coffey used to be a Republican state representative in New Hampshire. “I changed a lot over these years,” she said. “I used to think we could fix healthcare.”

Her experience with Medicare Advantage is not unusual. Private insurers now cover roughly half of the nation’s 68 million Medicare beneficiaries. Their dominance of this space has grown rapidly over the past two decades – at the expense of patient care, according to healthcare activists and patients, as corporations often deny medical care directed by doctors.

Gary – a retired physicist professor in Connecticut – fought two types of cancer over six years, before passing away in March 2023. He had been put on a Medicare Advantage plan as part of his retirement health coverage, through the University of Connecticut.
Gloria, and Gary’s daughter, Megan, spent the final months and years of his life battling with NaviHealth – his Medicare Advantage plan’s software, through UnitedHealthcare – which constantly denied covering Gary’s medical care and treatment, contrary to doctor recommendations.

Each denial forced them to either cover the costs themselves – such as a wheelchair, for $2,000 – or consistently file appeal after appeal.

“You’re worried about your loved one who is in a medical crisis, you are trying to get there to support them every day, and you’re having to fight these online battles with the health insurance company to try to keep them there,” said Gloria. “It’s just a horrendous additional stress.”
She was informed by both her husband’s doctors, and other experts she contacted for assistance, that the modus operandi of Medicare Advantage private insurers was to deny medical care coverage.

"i used to think we could fix health care."

me too.

medicare has carried me through cancer and diaberes with just a little help a blue cross supplement.

mt wife uses an advantage plan. be sure to read the fine print.

 

[Auld Phart]

"i used to think we could fix health care."

me too.

medicare has carried me through cancer and diaberes with just a little help a blue cross supplement.

mt wife uses an advantage plan. be sure to read the fine print.

I have Medicare and Tricare.

I hang up on Medicare Advantage calls

 

[rampart]

I have Medicare and Tricare.

I hang up on Medicare Advantage calls

they must spend more on advertising than they pay out on claims.

i'm trying to get my va upped to "service connected" due to camp lejeune, just in case.

 

[EvilEyeFleegle]

they must spend more on advertising than they pay out on claims.

i'm trying to get my va upped to "service connected" due to camp lejeune, just in case.

I have 100% VA..with minimal co-pays. They've saved my life three times over the years. With the Veteran's Choice program--I use community-based providers--top of the line Doctors and hospitals. The VA totally paid the cost of my by-pass and rehab. Totally paid for my prostate cancer treatment, including a 6 week stay in Seattle for Gamma radiation treatment. Yearly physicals, bi-yearly check-ups and $15 co-pays for meds.
I'm firmly convinced that I get better care with this program than I would get if I lived close to a major VA facility and had to use them instead.
A definite Rural advantage~

 

[Rambunctious]

The medical insurance system is a train wreck... Obama fixed two things that he still brags about... Medical insurance and school loans... how are both working for ya?...

 

[Donald H]

To all who are thinking about switching from traditional Medicare to Medicare Advantage--DON'T DO IT!

Delays, denials, debt and the growing privatization of Medicare

Medicare Advantage enrollees report treatment denials and delays in payment, leading to harmful outcomes in healthcare

www.theguardian.com

Coffey, 52, had been selling her belongings and raising money on GoFundMe to cover her medical care. To make things cheaper, she shifted her disability plan from traditional Medicare – a government-run health insurance program for older and disabled people – to Medicare Advantage, a program under which private health insurers contract with the Medicare program to provide health benefits.

With monthly premiums of $18.50 per month on average, Medicare Advantage often looks like a frugal alternative. However, private insurers keep premiums low by limiting providers and using byzantine cost containment tools such as prior authorization.
For Coffey, switching proved more expensive, as her Medicare Advantage provider, UnitedHealthcare, denied requests to cover treatments, medications and infusions she required.

Coffey used to be a Republican state representative in New Hampshire. “I changed a lot over these years,” she said. “I used to think we could fix healthcare.”

Her experience with Medicare Advantage is not unusual. Private insurers now cover roughly half of the nation’s 68 million Medicare beneficiaries. Their dominance of this space has grown rapidly over the past two decades – at the expense of patient care, according to healthcare activists and patients, as corporations often deny medical care directed by doctors.

Gary – a retired physicist professor in Connecticut – fought two types of cancer over six years, before passing away in March 2023. He had been put on a Medicare Advantage plan as part of his retirement health coverage, through the University of Connecticut.
Gloria, and Gary’s daughter, Megan, spent the final months and years of his life battling with NaviHealth – his Medicare Advantage plan’s software, through UnitedHealthcare – which constantly denied covering Gary’s medical care and treatment, contrary to doctor recommendations.

Each denial forced them to either cover the costs themselves – such as a wheelchair, for $2,000 – or consistently file appeal after appeal.

“You’re worried about your loved one who is in a medical crisis, you are trying to get there to support them every day, and you’re having to fight these online battles with the health insurance company to try to keep them there,” said Gloria. “It’s just a horrendous additional stress.”
She was informed by both her husband’s doctors, and other experts she contacted for assistance, that the modus operandi of Medicare Advantage private insurers was to deny medical care coverage.

Whaaaatttttt? Americans would actually hook into the private insurers' tricks??

This is equivalent to self-immolation to save yourselves from the horror of socially responsible reform!

 

[Greenbeard]

Get ready for more of this.

Conservative operatives have already sketched out what the GOP’s policy agenda would look like in the early days of a new Donald Trump presidency. As Rolling Stone has detailed, the proposed Project 2025 agenda is radically right-wing. One item buried in the 887-page blueprint has attracted little attention thus far, but would have a monumental impact on the health of America’s seniors and the future of one of America’s most popular social programs: a call to “make Medicare Advantage the default enrollment option” for people who are newly eligible for Medicare.

Such a policy would hasten the end of the traditional Medicare program, as well as its foundational premise: that seniors can go to any doctor or provider they choose. The change would be a boon for private health insurers — which generate massive profits and growing portions of their revenues from Medicare Advantage plans — and further consolidate corporate control over the United States health care system.

As The New York Times reported in 2018, during Medicare’s open enrollment period, the Trump administration emailed messages to millions of beneficiaries touting the private plans. Some of the emails included subject lines like, “Get more benefits for your money,” and “See if you can save money with Medicare Advantage.”

Trump’s administration also helped make Medicare Advantage more attractive by expanding the range of perks the plans can offer to enrollees, allowing them to add benefits such as transportation to doctors’ offices and meal delivery.

 

[debbiedowner]

To all who are thinking about switching from traditional Medicare to Medicare Advantage--DON'T DO IT!

Delays, denials, debt and the growing privatization of Medicare

Medicare Advantage enrollees report treatment denials and delays in payment, leading to harmful outcomes in healthcare

www.theguardian.com

Coffey, 52, had been selling her belongings and raising money on GoFundMe to cover her medical care. To make things cheaper, she shifted her disability plan from traditional Medicare – a government-run health insurance program for older and disabled people – to Medicare Advantage, a program under which private health insurers contract with the Medicare program to provide health benefits.

With monthly premiums of $18.50 per month on average, Medicare Advantage often looks like a frugal alternative. However, private insurers keep premiums low by limiting providers and using byzantine cost containment tools such as prior authorization.
For Coffey, switching proved more expensive, as her Medicare Advantage provider, UnitedHealthcare, denied requests to cover treatments, medications and infusions she required.

Coffey used to be a Republican state representative in New Hampshire. “I changed a lot over these years,” she said. “I used to think we could fix healthcare.”

Her experience with Medicare Advantage is not unusual. Private insurers now cover roughly half of the nation’s 68 million Medicare beneficiaries. Their dominance of this space has grown rapidly over the past two decades – at the expense of patient care, according to healthcare activists and patients, as corporations often deny medical care directed by doctors.

Gary – a retired physicist professor in Connecticut – fought two types of cancer over six years, before passing away in March 2023. He had been put on a Medicare Advantage plan as part of his retirement health coverage, through the University of Connecticut.
Gloria, and Gary’s daughter, Megan, spent the final months and years of his life battling with NaviHealth – his Medicare Advantage plan’s software, through UnitedHealthcare – which constantly denied covering Gary’s medical care and treatment, contrary to doctor recommendations.

Each denial forced them to either cover the costs themselves – such as a wheelchair, for $2,000 – or consistently file appeal after appeal.

“You’re worried about your loved one who is in a medical crisis, you are trying to get there to support them every day, and you’re having to fight these online battles with the health insurance company to try to keep them there,” said Gloria. “It’s just a horrendous additional stress.”
She was informed by both her husband’s doctors, and other experts she contacted for assistance, that the modus operandi of Medicare Advantage private insurers was to deny medical care coverage.

In Coffey's case If she only had Medicare she had no cap on the 20% she would have had to pay unless she had a supplement and don't know about her state but a supplement to Medicare for an under 65 person on disability would have cost her around $600 per month in premiums not to mention a Part D drug policy on top of that. Most Medicare Advantage have a max out of pocket for medical services around $4800 per year a few may have $6700 max and the drug plan built into it. So if she hadn't have had problems with pre auths she would have been better off at her age with the Medicare Advantage.

Gary being a

retired physicist professor probably could afford to purchase a supplement but felt he had to to take the what was offered through his job, which he didn't even if they had an HRA to pay for it. So Gary screwed himself. Also his sounds like an HMO. But the wheel chair should have been a shew in with no cost under durable medical equipment, unless it was motorized and then 20% out of his pocket.

I see stories all the time about denials and I in my 11 years on my Med Advantage have never had a denial or a pre auth longer than 1 week, with most of them being approved in 2 days.
I do know the denials exist and are frustrating and if someone bought one of the Med Advantage over the phone without having an actual agent to help then that is their fault.

Changes are coming to the pre auth process though and should make it a lot shorter for most, then again we shall see.

 

[Oddball]

We should be so lucky that the Medicare scam gets turned back over to market forces.