Medicare Advantage routinely denies reimbursements for necessary care, hospital execs say

31 million people are on Medicare Advantage plans, a private alternative to traditional Medicare. The plans are often cheaper and promise better benefits. However, the CEOs of rural hospital systems in six states told NBC News that Medicare Advantage routinely denies reimbursements for necessary care. NBC News’ Sam Brock reports.

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#MedicareAdvantage #Hospitals #Medicare

[nhansen]

Love how we force everyone to get health coverage but take no steps to ensure that the companies offering the health coverage will actually provide coverage.

[theRealJohnnyAppleweed]

Its almost like, ..health insurance is a scam... you dont say!!

[kdsqtee]

I am a retired nurse of 40 years and worked on the business side for 20 years as an auditor and patient advocate. I fought with insurance companies who offer Medicre Advantage plans daily. The one thing I always tell people is never give up traditional Medicare. Just remember when you sign up for Medicare Advantage you are giving your Medicare benefits to an insurance company to "manage". They will promise you anything to get you to sign over those benefits and then turn around and deny everything as not medically necessary. This is how they make their profit.

[Innovaterenovate]

As a Healthcare provider that does my own billing, I see patients lied to on a daily basis by these companies. It is heartbreaking to see good people taken advantage of.

[catenystrom]

THANK YOU THANK YOU THANK YOU for reporting on this!!!! Please continue reporting on it. I'm a medical social worker, I cannot get care, not even equipment like wound vacs, for patients on Humana Medicare, People's Health, UHC, on and on. They just deny, few facilities will accept them for things like rehab or home health. It's INSANE. People have to learn to just stay on straight Medicare A & B. It's worth the extra cost to have the care!! I live in New Orleans, this isn't just rural hospitals.

[gshew]

When United Heath Care (a publicly traded company on the stock market) is running it, they are certainly interested in their shareholders and making a profit, not the patient. Health insurance companies should not be public companies and traded on the stock market!

[bgregg]

There is NO ADVANTAGE for you at all unless you are perfectly healthy now & will remain so in the future.

[oMoM-djcg]

The purpose of private insurance companies is to maximize profits. You can maximize profits by denying as many claims as possible.

Private healthcare is incentivized to not pay.

[susancole]

Sad but very true. I’ve seen so many patients not get the care they need, especially for acute rehab after strokes, etc. It rarely gets authorized by Medicare advantage patients. It really impacts recovery & outcomes.😢

[MrsJones]

This is why you need universal health care.

[Me]

Everything about the United States of America makes things difficult for working people, the middle class, and the poor

[tammyc]

They are told to automatically reject 10 to 30% of the claims even if they are billed correctly for nursing homes in CT. CMS is working to change this in CT.

[patdenman]

I have had 2 different Advantage plans and back to register Medicare. I found that Advantage plans are long on promises but short on delivery . One denied pain patches as I am allergic to nsaids and the other would not cover treatment at the rural hospital near my home!

[monkhasheart]

Yep - two standard cardiology tests. I left it up to the Dr's office to make sure the tests were approved. I was on the floor passed out in their office when this happened. BUT even though the facility and Dr are in network - the advantage plan denied coverage. Just a heads up for those of you with an advantage plan... standard cardiology tests when you are on the floor unconscious aren't covered.

[jodianderson]

My husband and I recently enrolled in traditional Medicare. We researched the Medicare Advantage plans and traditional Medicare and because of investigative news stories such as this and other resources, we chose traditional Medicare. Medicare Advantage has no advantage and they require "pre-authorization" (i.e., an ok from insurance companies for procedures). And many times they don't cover you if you travel. They are just a cash cow for private companies.

[marilynnjefferson]

Many in Louisville, KY, lost access to primary care in mid September (NOT Dec 1) when Humana broke the Medicare Advantage contract ended early. Where are lawmakers? How much are insurance companies contributing to election funds?

[taloweryus]

It would have been nice if they had mentioned which Medicare Advantage plans were the worst offenders, or at least which ones were involved with denying coverage to the clinic in question.

People should be told that they are not protected by Medicare rules if they choose an Advantage plan.

[cherylhowe]

I was told many years ago to say no to an Advantage plan and yes to a Supplemental plan. I've had no problems.

[callicordova]

The amount of advertising these Medicare "DisAdvantage" companies do should give you a hint. And a lot of it is insulting and demeaning to older people.

[angelasieg]

I used to be a claims specialist for one of those insurance companies. They will auto deny banking on the insured not being willing or able to fight the denial