Medicare Advantage routinely denies reimbursements for necessary care, hospital execs say
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- Опубликовано: 13 дек 2023
- 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
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.
We're the only country that lets our Healthcare System be like this. If we just paid 2% tax we could just go to hospitals without worrying about cost. US Healthcare is so expensive because of Administrative Costs, useless jobs to process insurance numbers and so forth. We don't need that. Just pay our doctors, nurses, researchers, and forego insurance models.
These are private plans that were making private Investors richer at the expense of patients. The investors are getting what they deserve for ripping people off. The patients are suffering though.
Why do people keep blaming the government instead of the healthcare company that did this.
In Japan, by law you need to sign up for health insurance but you don’t hear people blaming the government for it
THANK YOU @@jankuni
Even when they can get coverage, it doesn't mean they'll get the care either.
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.
Problem is that many people can't afford the supplemental plans.
Medical coverage in the USA is expensive and useless. The worst in the world.
@@les0101s That's true. However, if you have health issues and see a doctor frequently, you may end up paying out a lot more with the Advantage plan every year. My husband is a cancer patient and we do pay a higher premium for his supplement plan. But, we have no worries that his care will be denied or that the Mayo Clinic will drop his original Medicare/supp. plan.
I found this out the hard way 😕
@@TheViewTube4U Traditional Medicare has nothing to do with Obamacare. In fact, many Republican politicians have championed Medicare Advantage Plans that turn your traditional Medicare over to a private insurance company.
Its almost like, ..health insurance is a scam... Noooooooo, you dont say!!
Private corporations in the health insurance business are specialists in scamming the system.
I agree with you 💯% This is absolute TRUTH.
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.
Are there plans that are better than others
@@felisha209 Yes. Some Advantage Plans are PPO's and have a larger network of providers. With the zero premium plans, you're limited to a narrow network. As with anything, the devil is in the details and where you live. MA plans can end up costing you thousands out of pocket should you become sick or injured. You may also be required to get a referral to specialist or get prior authorizations for treatment.
There are a lot of good RUclips channels that go over the pros and cons of all the plans, including the Medigap/supplemental and Part D plans. It really pays to be well-informed, even though it makes your head spin!
Contact your states insurance commisioners office for further assistance!
Contact your state for further assistance for what helping denied from Medicare Advantage or a better Medicare Plan what I'm in the process of looking myself I was kicked out of Medicaid ACA has an income bracket I just want Medicare or I can afford Healthcare why in America are we like this
There is NO ADVANTAGE for you at all unless you are perfectly healthy now & will remain so in the future.
Yep you are exactly right.
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.
Let me rephrase that for you: Private/for-profit insurance is incentivized to not pay. Private/for-profit medical, home, auto, long-term care, etc insurance will always find a way to weasel their way out of paying your claims.
Universal healthcare would be amazing
@@davidcachehow would it be…seems to me it would be the same as the Disadvantage plans…
@@queenieny4654 right now, care providers are being charged 300 dollars for a pint of salt water (saline solution) on an IV drip. Our insurer is charged up to 3,000 dollars a day for a hospital room... Universal healthcare would make healthcare a right, rather a service, naturally that would lead to to regulations. If the tax payer is flipping the bill, we can stop private companies from charging 300 Dollars for a pint of salt water, we can regulate the cost of hospital stays. We can pay less for better service.
@@queenieny4654 No, bc universal healthcare would operate as a nonprofit does. There would be no shareholder to pay. They would only need to charge enough to cover their costs. That’s why costs would go down and the quality of care would go up. Other countries are already doing this.
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.
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!
United Healthcare also offers a MediGap policy under original Medicare and it is a Plan G, which is excellent.
And??? They will continue to profit by limiting access. Terrible for the policy holders!
@@gshew1871I would rather starve and find the dollars 💵 to pay for a Medigap to go with my original Medicare…I will never go into a Medicare Advantage plan…
@@gshew1871 Medigap plans are different. Private insurance companies offer them to cover the 20% that original Medicare does not. They are required to cover and approve anything that Medicare does. You can see any doctor that accepts original Medicare (most do) and your Medigap is automatically accepted. There are no prior-authorizations or referrals required. Medicare Advantage plans are completely run by the private insurance companies and they decide if you get care or not. The cheapest plans have limited networks.
Healthcare should not be about profit or markets. #single-payer
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.😢
You can appeal.
I sell medigap and advantage plans. I've never had a person denied coverage that we couldn't appeal and get covered. People forget that Medicare leaks $100,000,000,000 a year in fraudulent charges. Advantage programs are combating that by having a prior authorization process. As long as you can prove you're a legitimate doctor ordering necessary treatment there is never a problem. Doctors are making less as a result because they have to hire more administrative assistants to help get paid and as a result they spread hate on the advantage system because they'd rather see more patients and make more money too. There's always two sides too a problem.
That's horrible.. But who does the appeal if the patient is alone and has nobody..?
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.
This is why you need universal health care.
Denials are worse with universal healthcare. Then it’s the federal government denying your services. The feds don’t really negotiate.
To bad republicans brainwashed their constituents into believing socialism is bad.
How is that different??
@@queenieny4654 Universal healthcare is basically insurance that is operated as a government agency. They would have no shareholders to pay. Their only goal is to provide a service and cover the cost of the service.
Yes, but to Americans that’s scary communism!
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.
CT. is one state that will get it done. The A.G. is very smart & tough.
good to hear, thanks for posting this
I just had this conversation about things done in CT, having lived there for years and having since moved. Getting air to adjust and correct tire pressure is mandated as free everywhere in Connecticut by CT law. You should not need money to be able to get safety off the road .... and cause a disaster for everyone else near you. Things like this are what’s done right in CT. It helps to be one of the smallest states in the country but CT gets much right, that’s for sure.
does Medicare Advantage cover nursing homes ie. long term care in CT?? They sure don't in NY state!
@@noble604 well, I'm happy to hear they are doing things like this because they sure get you on the taxes, don't they? When my son moved there and told me he had to pay a tax just for owning a car, I was aghast! What???
Everything about the United States of America makes things difficult for working people, the middle class, and the poor
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.
I am pretty sure a story made the news with similar circumstances. The person collapsed and had to have an emergency heart surgery. The insurance denied it saying the person failed to get a prior approval for the surgery.
Jesus 🤦🏻♀️
😢
Did you or do people ever dispute their denial of the claim? Of course, that's a nightmare if you're ill, but even before I was on Medicare I knew of so many people who were denied surgery, or medication etc etc that was absolutely necessary. A few disputed but one man I knew was suddenly denied a prescription that had been keeping him alive. It was suddenly labeled "experimental". He died 2 weeks later before he even got a chance to dispute it.
My big shock was my co-pay for out patient procedures. Unfortunately, last year (my first year on Medicare Advantage ) was a big year for me for that. I needed several endoscopies and I broke my wrist and had two outpatient surgeries for that issue. My "co-pay" for Outpatient procedures is $400!!!!! Thank God the hospital allows payment plans!
The bottom line is PROFIT, PROFIT, and PROFIT. End of your healthcare.
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?
In-depth investigative reporting documentary badly needed here. Netflix exposure has brought other social injustice criminals to light in ways that had a real impact.
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.
Thank You! I'm turning 65 next year and will be using Medicare and worried about if I'm going to make the right decisions when signing up. Hubby will need to use the Medicare but I can also go the VA route.
@@julieinthenorthwest4594 I've known a couple people who are covered by the VA and in my limited knowledge based on their experiences, the care can be spotty. One friend went in with a kidney infection. He KNEW he had a kidney infection, he'd had 2 or 3 before. They INSISTED it was the flu and sent him home with Tamiflu...which he didn't take. Three days later he was in the hospital with a fever of 104 and sepsis. Another friend went to their dentist and had a root canal procedure. The crown fell off within days. He went back two more times and the same thing happened. (it wasn't because of teeth grinding or anything he did). It was crazy! I could share a couple other stories, but I'll leave it at that. Obviously, that doesn't happen to everyone all the time. There are always instances of less than top care wherever you go. It's just that they are the only 2 people I know who are in the VA system and they both have had pretty big issues.
My Medicare advantage provides my ride. It cost me nothing. I have been given rides up to 2 hours away.
people I know can't find a ride or denied so may not be the norm
Oh, you mean “death panels”?
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.
United healthcare is horrible
Yes, agree, and the last lady didn't really tell us what the problem was. It sounded like she signed up for a Medicare Advantage Plan, but her doctor wasn't on the panel of providers. You have to check into that before signing up.
@@les0101s In our area, providers simply stopped accepting some Advantage plans and left patients in the lurch.
@@les0101s And, there are dozens of Medicare Advantage plans to choose from! It makes it very difficult. Of course, we're seeing this right after the open enrollment window closes. 😜
@@dod2304 I know, I thought the timing was strange too. I use the Medicare.gov website every year to compare plans and narrow it down pretty quickly. It was really confusing at first, though.
Not surprised at all. The companies exist to make money, period.
Those DISADVANTAGE plans are the worst! NO way would I ever sign up for that.
Me either…
I can’t believe the states of WV and KY are not on this list! A lot of Hospitals in these two states have had to close because of the lack of reimbursement and the high poverty levels. Rural healthcare is in crisis in these two states, yet their elected officials neglect to report it or ask for assistance.
Then why do you keep voting for republicans. Their goal is to destroy public schools and defund any medical care for the middle class and seniors. Kentucky votes against their own best interest.
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!
The health care system just does not work, there is no getting around it. The question is when will people do something about it.
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
That is so wicked and evil…
@queenieny4654 Yes, it really is.
And when you do follow through with the evidence of its appropriateness they still automatically deny a few times.. all while you are ill and struggling to survive.
@monkhasheart I had to get a lawyer. Many times, the patient will need help sorting through the deliberately hard to navigate process. A spouse, a caretaker, or an adult child. Honestly I've thought about becoming a freelance to help those who have to deal with. I have been for the last 4 months after an accident my insurance doesn't want to pay for. I know their dirty tricks. I've been trying to deal with it with a head injury. I'm not defending insurance companies whose business profits not helping their subscribers.
As a human being, how were you able to justify working for such immoral companies?
We have the worst medical system in the world. Even Mexico, Cuba and India have better medical coverage than we do and it doesn't cost a fortune.
And the nurses and doctors are so much warmer and kinder in Mexico than in cut-throat USA. I can't speak to Cuba and India as i haven't seen any nurse or doctor there.
I used to work for a hospital that sells these plans and holy crap do they skimp on necessary procedures when they can. Insurance is a gamble where the for-profit companies bet on you being healthy while paying them. If the bet is too bad like say end-stage renal failure (kidney shutdown), they won't even begin thinking about covering it unless they add on some exorbitant side fees.
During COVID-19, my hospital was on blast because the head doctor was pushing expensive, elective surgery when we had a plague on. I believe he moved to USC after the scandal because doctors got together for a signature. I later found out that they were also using shady practices to dodge taxes since the 2000's, so left for another job as soon as I found out.
Staying after finding out would have been criminal - akin to abetting a crime.
Regarding “expensive elective surgeries”, the vast majority of these surgeries are medically necessary, and delaying these surgeries resulted in worsening health for many patients. The hospital where I work begged the state of California to allow us to resume elective surgeries, for the sake of patients health and for the financial health of the institution. Early in the pandemic half the hospital beds were empty anyway since Covid didn’t really hit California until that winter. Anyway, plz don’t downplay the importance of elective surgeries.
@@sarahjane4908 pfft say that to "plastic surgery" and other such procedures. This is in PA.
@@hnfiiinc5993 A person who works in the healthcare industry knows there is a world of difference between elective surgery (medically necessary surgery that is scheduled, i.e. not an emergency) and cosmetic surgery.
We had one insurance through our film industry union. Then when we retired, we were told by our insurance company that we HAD to now be on Medicare Advantage. And now, there are NO doctors or medical groups within 100 miles that will take our insurance. This is after paying the highest price for the best insurance plan available for 50 years. We’d get better medical coverage if we’d live in poverty all that time, on Medicaid.
Why would you have to be on a Medicare Advantage plan? And why can't you switch to Medicare during open enrollment?
People have nailed it. In a family medicine office they have 5-6 people working on billing alone. Each insurance company adds extra complexity. If we had medicare for all it could be just one and we could lower prices
Maybe. More likely is that doctors would buy bigger houses though. Savings sometimes, but do not always go to the consumer. As far as medicine goes, I think the later is the case.
I’m a biller for home health and united healthcare and Humana can stick it where the sun doesn’t shine
I was told many years ago to say no to an Advantage plan and yes to a Supplemental plan. I've had no problems.
Health care like everything else, let me say once again, "It's all about the money"!
Great job NBC, getting this article out a week after the Medicare enrollment period closes.
This information has been available on RUclips by the Senior Savings networks for years. If you’re considering MA please do your research or you will regret it.
I heard a problem with Medicare Advantage a year or so ago but I couldn't remember exactly what it was I appreciate the story. I knew it was a private company. not Medicare
True, but to be honest, the corruption of Advantage plans has been common knowledge for the last two decades.
And giving minimal information---but this is what corporate America has brought us to---they own all the broadcast news stations & since the news doesn't make money for them, they've restricted them to 30 minutes of brief headlines. Remember when the nightly news was one hour, did in-depth reporting & investigative reporting? Hardly any of that now, I'm surprised the Profit Lords let NBC off the leash to criticize the health insurance industry. But this is what happens when money is king & capitalism is god.
Medicare enrollment happens when an individual turns 65. It's not a once a year thing. The yearly enrollment period is for the advantage plans.
Sounds like we should just enact a Universal Healthcare plan and call it a day 🤷
But universal health care would create too much government intervention in health care decisions, says the political party intervening between a pregnant woman in a medical crisis and her doctors.
Exactly 💯
Any insurance paid claim is seen as a loss, because it takes a bite on their profits. I worked in the insurance industry many years ago, when a precondition could cancel or denied coverage, the ACA put an end to all of that, but several of these companies have a specialized team finding the loop holes to cut/denied coverages, and these high paid individuals will use all their college edu knowledge so they can get their bonus. A healthy young adult or dead person is more profitable, but a sick individuals will eat up all your profits. Simple as that
Is it worth disputing denied claims in your opinion?
@@dod2304 absolutely! Likely ending up talking to 3-5 different people, because they all got the same ridiculous memo, but eventually you might get the end result you want, in other cases talking to a lawyer may be at best. I will never forget when I interviewed for a company that quacks several years ago; before the aca they was selling two health policies, both the same price, but one cover half of the other which included the most costly of health issues, if half policy was sold, the agent would get 39-45% of the total sale and a another % on policy renewal, and if the goal sell was a reached this would included a bonus, because you saved and made profit for the company. I didn’t take the job offer, but that is the sad reality in insurance practices.
if yoyu notice the states that are having the most problems are the ones that refused to expand Medicaid ..if they did, these senior citizens would have the benefit of being covered by the combination of both medicaid and medicare with no denial of services .. .California has a lot of problems ,but their dual coverage for low income seniors is top notch.
If Medicare advantage denies so does medicaid, Medicaid is always secondary to any insurance, if the primary insurance denies so does Medicaid.
@@bellaannecgoff2335 For seniors, Medicaid helps pay your premiums.
But California also has some markets with fabulous Medicare Advantage plans, like the desert communities. Because of the high senior population and great medical groups, they have a lot of power to get good MA plans including the best doctors and hospitals. Also, some medical groups offer educational seminars to educate you on the best MA plans for that year in your area and provide comparison breakdowns so you can make wise MA plan decisions. My folks have had over 20 years of terrific Medicare Advantage plans with hardly any copays and few denials, none of which we were not able to successfully appeal. From heart surgeries to autoimmune conditions, all went smoothly with low costs.
Evil people doing evil things and you just sit there and take it
A TRUE FACT these folks & the companies they work for are Greedy, scammers and CON-ARTISTS. 👿👿👺🔥👎
As a licensed agent in more than half the country and appointed with several carriers... it feels like I'm the face of lies these carriers "provide" and I'm responsible in the end. Not only that but I have my own medical issues and my coverage has taken advantage of me.
I deal with these insurance plans everyday. The patients truly need the services, but constantly having to appeal the insurances decision to stop treatment, when they clearly need it. Beyond frustrating for them.stay on traditional Medicare
Why doesn’t media tell us who in congress is being paid by insurance industry lobbyists? Why don’t they report on the health plans that congress has?
You do know that Congress people have free healthcare for life don't you? They pay ZERO. EVER. Please tell me why they deserve that? And as they enact laws that directly impact the way insurance does business and OUR care, doesn't it seem a conflict of interest? Or at the very least a problem they don't have to ever think about themselves and don't have much empathy about.
Private healthcare organizations and HMOs are like insurance companies-their goal is to DENY as many claims as they can get away with. That’s how they make money.
Private companies using government money for patient care while not using it for them and reporting record profits… im shocked this could happen🤡
Educate yourself and change your plan during open enrollment each year if necessary. I had an Advantage plan and found they did not have specialists in my condition and would only refer me to a practice I'd previously left. I waited 3 months and changed to a Medicare Supplement during open enrollment. It's twice as much as your Medicare insurance payment, but I have no out of pocket cost and I can see any doctor or specialist of my choice.The supplement pays any remaining costs that Medicare approved but where they don't pay the entire cost such as copays. 🤔🤔🤔
I struggled to afford original Medicare the whole first 15 months I had it because I wasn't yet old enough for my own SS retirement benefits and was struggling on my deceased husband's SS survivor benefits. Didn't matter: I pinched pennies and did everything I could to pay for original Medicare, because there was NO WAY I was going to take a Scamvantage policy. Now I'm on my own benefits. It's a little more comfortable, and I am so glad I made the decision I did, even though I could barely afford it.
My 86 year old mother had to get off her supplement because the cost was sky high so they got her on the advantage that claimed just as good care but cheaper than a supplement. It was all lies and her medical bills are wiping her out financially now,
It is all based on location. Some areas of the country have great Medicare Advantage plans with wonderful coverage, but it is because there is a huge market of seniors. My folks had brilliant coverage in Southern California desert region because senior numbers are huge, the best medical groups are in the MA plans, along with the best doctors AND hospitals. We have 100s of plans but great seminars to educate you on the best ones for that year and for you personally. You must research the plans or read the book "10 Costly Medicare Mistakes You Can't Afford to Make."
Terrible! These people have no souls. I am so sorry.
Privatizing healthcare cost more and gets you less
I am so glad I opted for original Medicare and a Plan G supplement 3 years ago when I became eligible. I was less than a year out of a cancer diagnosis at the time, and I'd spent so much energy (that I didn't have to give) on arguing with my pre-Medicare insurance to get the necessary treatments during that time. The day I started my Medicare coverage all of that fighting for care and network and pre-approval nonsense vanished. The premiums and LOW deductible I pay are far less than what I paid for my other insurance, and worth the security of knowing that should the cancer bug bite again, I won't have to wait or jump through hoops to get the care needed.
Glad to hear that you have good coverage.
No one will take the insurance. Americans are one medical bill away from losing everything and all it takes is for them to deny a claim.
Too bad this i fo didn’t come out last week when people were reviewing their medicare coverage.
This report is just one of hundreds that have been released to the public over the last 15 years. This problem did not spring up over night. People need to do their homework instead of relying on paid celebrities for their insurance information.
@denali9449 definitely do their homework, but how are they to know medicare advantage just won't pay out?
@@koenigxolo Like I said, this did not spring up overnight - it has been in the news for at least 15 years. Doing your homework includes being an informed consumer who has learned which are the problem companies. HINT - it is all of them who offer an Advantage plan.
@denali9449 not surprising, but it's news to me.
@@koenigxoloBecause it DOES pay out if you choose the right plan, live in an area with great plans (like So. CA), ensure your doctor's office codes correctly and ALWAYS appeal any denials. Folks have had 20 years of great Medicare Advantage coverage!
Apparently, the "Advantage" is for the managers, not the patients with the coverage.
Thanks for finally doing some investigative reporting. We need MUCH more investigations!
Medicare Advantage is not accepted by a local ER where the waiting time for triage and treatment is less than 15 minutes. I was instead referred to another hospital ER where I sat for over 3 hours before I left without being treated. They still charged me $90 simply for being there. All I needed was an ultrasound, and they have a radiology dept but they wouldn't send me to radiology. The irony is that the ER that charged me $90 for nothing, and the Medicare Advantage plan that I have are both with the same organization. So, they ended up billing themselves for the $90, and patients end up with little to no service.
Before you sign up for a Medicare Advantage Plan, you have to check their list of providers to make sure your doctors and hospitals are with the plan.
Unless you are emergent, it's best to go to in network hospitals or ERs . You should be glad the first hospital ER didn't bill you more than $90 bucks for a triage assessment. I'm sort of confused if you weren't actually thought to be emergent (otherwise the first hospital would have tried to save your life) why you'd go through the ER just to schedule an ultrasound. Sounds like that could have been scheduled through radiology separately or maybe a higher level urgent care with radiology on site..
@@les0101s True, but that doesn't help the people who signed up for an Advantage plan when their doctor was in network, but then stops accepting the plan. That's what's been happening in our area. Many providers are simply dropping them, leaving patients in the lurch.
@@ga6589 I haven't had any problems, but I'm in a big city - Portland, OR. I have a newer plan called Devoted Health. In the past, I've also had Aetna, Blue Cross Blue Shield and United Healthcare and they've all been good plans. I had a supplemental plan the first few years, but the costs kept going up. Also, I had to have a Supplemental for Plan D and that was much more expensive than the Medicare Advantage Plans.
@@ga6589 Why the Medicare Advantage discussion should be based on LOCATION as some places (like Southern California) have fabulous plans with strong medical groups consisting of the best doctors and hospitals. Our area medical groups also sponsor educational seminars where the best MA plans are discussed so you can choose among the competitive plans and be sure to get the coverage you need. California also has a special enrollment period and also Birthday rules whereby you can revert to Original Medicare on your birthday without underwriting for the supplement plans! So all is dependent upon the area in which you live. A good discussion when one is planning WHERE to retire.
I tried to share this on fb and got an alert that they removed the content. So wierd. Why did that happens?
Stay away from dis-advantage plans!!!!!!
I’m learning the hard way. Now I have cancer and I’m broke
The United States needs to do like Canada. Everyone gets healthcare coverage and then we can focus on other things. People have to choose between a medical bill/medications or groceries.
Oh but the US is ALL about profits and getting wealthy dontcha know?! Especially, those people in Congress who get lots of donations and perks from those insurance and pharmaceutical companies! The propaganda has been the same for years..."we're the best healthcare system in the world!" People are starting to wake up...
And yet Canadians come to Washington and California consistently for medical care. Oh, and what are Canadians obesity rates as compared to the US?
Not surprising. Greedy corporations!!!
If you are denied ,demand an appeal. It is not a healthcare person making that decision.
We have always won on every appeal we made with no problem, whether for a service or medication. Also, watch your doctor's coding. Often the doctors are making the errors (from a medical family).
Come on, do better reporting. Interview regulators, policy analysts and politicians about what efforts are being made to stop this, or who’s stifling these efforts. Name names and political parties, so people know when elections come around why it matters so much who they vote for.
Also, do some balanced reporting showing those areas with great Medicare Advantage plans and happy customers. Location is everything.
Yes….its deny….appeal…..correct documentation……deny….appeal…..approve (maybe)…..over and over!!!
Yep, happening right now with my mum.
Where is she located, as location is everything for Medicare Advantage plans. You may turn to a Boomer Benefits advisor for help as they are excellent in this area.
Public health service like Europe needed... Nothing with corporations.
WE saved my father's life THREE (3) times in a European hospital as they wrote him off as being elderly and having "lived a good life"-- a common thing in Britain and Ireland...ageism. Nurses had no autonomy so you were always waiting for third-world foreign-born consultant doctors to give approvals to the nurses for simple actions such as changing catheters, etc. We fought for brain scans re new bleeds, fought for labs when we recognized low sodium coma conditions, and took over medication management when nurses didn't understand blood pressure specific titration of certain meds. We changed catheters ourselves rather than await a bladder infection. Dad lived another NINE (9) years after we rescued him home to Southern California care, where he had more tests and labs done in the first 30 minutes at Eisenhower Medical Center than in all 8-1/2 weeks overseas! I would not wish another 8-1/2 weeks in a European Healthcare system on anyone!! Thank goodness we were a well educated medical family!!
My sister right has almost undetectable iron levels, she can barely move and they are not approving an iron transfusion for her. She can barely eat because she also has a necrotic ulcer that the doctors are taking their time treating.I think she's just decided to die at this point rather than keep fighting the system.
I have prayed for your sister, that’s horrible!
1 Corinthians 15:1-4
She needs a smart, capable person to advocate for her. If she has no iron to transport oxygen throughout her body and brain, I imagine she can’t perform well mentally and is lethargic.
@@genxx2724 we have tried, the problem is that her husband is abusive and controlling and really doesn't care. Before it got to this point, we asked her to sign paperwork so that we could advocate for her, but she was afraid to upset her husband. Now she's in such a terrible state she doesn't have the energy to do it, and honestly I don't think she would because she's still afraid of upsetting her husband.
@@theundone777 How awful! Just sickening and heartbreaking.
@@theundone777 So sorry to hear this, everything the husband is doing to your sister is being recorded in the books in heaven, he will get his due when the time comes. Saying a prayer for your sister..
Unfortunately, that is how the private sectors work. When someone claims you can pay less for more coverage, that should be a red flag and you should dive deeper before you made your decision. They just put details in a lot of fine prints (or hide it well) and expect you to miss them.
I wish I knew which plans were apart of this study. Knowing the road blocks is better than just hearing about it 🤷🏽♀️🍎 thank you for the report
That’s what for-profit companies do.
One risk pool is a health care system. Multiple risk pools is an investment scheme. We have enough investment schemes in this country; we need a health care system.
I have United healthcare and Optum through my union. Optum requires pre authorization and still deny deny deny. Although advantage plans take money from our hard earned medicare contributions. It's all about profit for the advantage plans they don't care about the people they are suppose to serve. Someone needs to make them accountable.
This report is about Medicare Advantage insurance plans which is insurance sold by the insurance companies. Don’t be misled with the slick ads from the insurance companies. Enroll in original Medicare not a Medicare Advantage plan, they are not the same thing.
1 out of 5 claims are denied by for profit insurance companies! 😡
But stupidly only a very small number appeal. We were 100% successful with every appeal we made for the very few denials my parents received under Medicare Advantage plans.
they should change the name to medicare-take advantage of you.
How is a health care insurance company a publicly traded company with shareholders?Does that not show what they are about? Scam scam scam
Private insurance in healthcare should be broken up and limited now. Paying into something and paying more out of pocket even through we are paying insurance
All of these insurance companies should be shut down. Medicare for all
My parents are on an advantage plan. We recently had a serious life threatening emergency with my father that required him to get emergency surgery done. Unfortunately this surgery was a very specialized surgery and this all happened around the holidays. The hospital he was at orgionally couldn't do the surgery right then and there so we had to track down a hospital in the area if they were able to do it. Now, we are in the Philadelphia region, home to some of the best Healthcare systems in the nation with not just 1 but 2 ivy league medical universities including other very good Healthcare systems. We had such a horrible time trying to find a Healthcare system that accepted his advantage plan. Took a few days meanwhile my dad who was critical kept getting worse and worse. We finally was able to get a Healthcare system that could do the surgery and accepted his advantage. He is alive and good thank God but that really was a huge eye opener. Needless to say, he is rethinking his advantage plan.
We call it Medicare Disadvantage for a reason.
I think this is part of the reason why medical cost so much. The auth department for my medical company larger than the office staff.
NATIONAL HEALTH CARE PLEASE
Its a scam.
This is critical issue affecting millions of Americans deteriorating their necessary medical care forcing them to suffer despite of their hard working and paying for Medicare entire lives
The more they deny. The bigger their profits. So why not?
Not a surprise at all.
I just watched them jerk my parents around.
Dad 80 had a bad fall in July. Obliterated his humerus, large clot, and several brain bleeds.
Surgery on all of the above.
A stroke
So many appeals.
They sent my dad home w my 78 yr old mom to take care of him in Oct
With no home health
Glad I have the public health service in Spain 🇪🇸🇪🇺🌹👍
Traditional Medicare
Your milage will vary with advantage plans , but having a relative suffer a heart attack in rural Alabama in 09 local ER was covered, $44,000 med flight to Huntsville cost $50 bucks, Stents in huntsville, cardiac critical care for a few days covered after all the deductables and co pays hit their max. .
With MA plans, it is LOCATION, LOCATION, LOCATION! Folks have loved their Medicare Advantage plans over 20 years in So. CA.
Laws should make ADVANTAGE plans equals MEDICARE
Imagine that, an insurance company that doesn't want to pay out. 😂😂😂
My parents are both battling the nightmare that is Medicare Advantage.
And, that's the LAST thing we should want for our grandparents and elders. In general, we don't cherish and respect our elders like so many other cultures do. We are a youth worshipping culture. With very sad and tragic results.
Where do they live, which is the crucial question as some markets have fabulous Medicare Advantage plans and coverage!
I had no idea and now Im literally disgusted. We all need to pray this bubble will break. It won't happen until the system breaks because these plans attract people with low incomes, which is millions of people of Medicare age.
Thank the Docs for this!! Docs are losing patients for not accepting Advantage plans, this happened to me!. I live in a largely populated area which Advantage plans are accepted, we haven't had one copay, nothing out of pocket, all our Meds are free. After being informed that my Cardiologist group dropped Advantage plans due to them feeling they weren't being paid enough, within minutes I had an appointment scheduled by a Large well known Cardiologist group who accepts are ADVANTAGE PLAN, they have gotten hundreds of new patients since Baptist stopped taking A.P. Time to blame the Docs for their greed! BTW my surgery was 179,000 with my Advantage plan my total out of pocket was 140.00 so tell me how bad AP are!
I tried United Healthcare Nedicare Advantage in 2023....they denied claims for in network provider services....traditional Medicare is now my choice
This supports my choice to keep my Original Medicare separate from my Medicaid and not smoosh them together for the sake of a few nice lures affixed to draw me in. I do not live in one of the states included in this story but, I think, it may be only a matter of time in that sense.
This is a nightmare!😮
Coverage that does not pay isn't coverage. One American! One Standard! One Payer!
Geez! I guess we are quite lucky here in Miami Dade county. My Medicare Advantage is a 0 copay per visit and for tier one and two medications, we don't need a referral to see a specialist, covers the gym, offers transportation and gives us $220 quarterly for over the county meds and supplies. Right now my husband and I are being treated by Mount Sinai primary care physician and specialists.
My mom also has a fab MA plan here in Southern California. The best plans and experiences are in areas with high senior populations where the political clout is great. We have great strong medical groups with the best doctors and hospitals. Has been great experience even with heart surgeries and other comorbidities.
🎉I retired three years ago, didn’t understand the difference in original and advantage insurance until two of my white neighbors explain them to me. I went with the original Medicare and purchase a supplement insurance which is higher but I choose what doctors I want to see and pay nothing out of pocket. Advantage they choose your doctors, it’s okay if you don’t have any underlying conditions you may not be able to see the doctors you were use to seeing.
Ye gads, took the media long enough to finally report on this. Medicare Advantage plans would be more descriptively accurate if they were actually called what they really are i.e. Medicare Disadvantage. Stick with original Medicare and a supplemental plan seniors and a part D prescription plan. Better yet, make original Medicare available to everyone, like every other developed country in the world that has Universal single payer health care.
Never ever call these companies was told this years ago
I'm just wondering about the timing of this story. Did it not occur to them to get this out BEFORE open enrollment (when people choose or change their Medicare plans) closed? That was Dec. 7th.WTAF??!!
Have you had your head in the sand all your life? These discussions have been going on for over 15 years. With no disrespect, anyone who is not aware of this situation deserves what they get. Secondary to that is that for the majority of folks, due to the pre-existing conditions clauses, there is no switching to traditional Medicare with a supplement.
@@denali9449 Gee thanks for the kindness. Yes, I guess you could say I've had my head in the sand. I'm brand new to Medicare and have had a whole lot of OTHER issues in my life needing my attention. So, I apologize for not knowing everything everywhere all the time. How thoughtless of me.
The 3 D of the insurance industry Deny, delay and defend!
STOP CALLING IT MEDICARE