The Secret is Out: Medicare Advantage Plans Deny Large Amount of Claims

As licensed Medicare brokers, we have occasionally seen our clients with Medicare Advantage plans have issues. These may include billing issues, denied claims, and having to wait for medical services. Over the years we have only had our own anecdotal evidence on the topic; there hasn’t been any cumulative study to show what our clients have been experiencing with these plans. That changed recently.


A Bombshell Federal Report


On April 28th, 2022, The NY Times covered a bombshell federal report detailing what we already knew: Medicare Advantage plans are denying claims en masse. The federal investigators found that these private insurance plans had “widespread and persistent problems related to inappropriate denials of services and payments”. The report detailed a system that denied almost 1 in 5 claims that should have been covered by Medicare, totaling 1.5 million denied claims in 2019. Other issues included patients waiting months for care to be approved, paying for services that should have been covered out of their own pocket, and doctors spending hours a day trying to get care for their patients. [1]


AARP Weighs In


AARP, one of the biggest interest groups in the country, has also reported on Medicare Advantage denials. They released their own story on this federal report around the same time the New York Times did. Their article highlighted how Medicare Advantage plans “can delay or prevent beneficiary access to medically necessary care; lead beneficiaries to pay out of pocket for services that are covered by Medicare; or create an administrative burden for beneficiaries or their providers who choose to appeal the denial.” [2] They also had some real-life examples of Medicare Advantage members having delayed or denied medical services.


This is a huge deal, as AARP has a branding partnership with United Healthcare. AARP has their name on many United Healthcare Medicare Advantage plans and are openly pointing out the flaws in said plans.


What Can You Do to Protect Yourself?


The best way to protect yourself is to know the risks of a Medicare Advantage plan before you sign up for one. You must have a trusted broker in your corner who can properly explain the pros and cons of the Medicare Advantage system. Don’t fall for commercials and letters hyping the ancillary perks of MA plans such as gym memberships and grocery cards. Make your Medicare decision based on healthcare first.


Talk to the brokers at NJ Life & Health to get a proper Medicare education. We will guide you through the entire Medicare system so you can make your own informed decision. Reach us at 848-226-6897 or visit our website at www.njlifeandhealth.com.

Citations:

Abelson, R. (2022, April 28). Medicare Advantage plans often deny needed care, federal report finds. The New York Times. Retrieved June 22, 2022, from https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html


Bunis, D. (2022, April 28). HHS says Medicare Advantage plans deny some needed care. AARP. Retrieved June 22, 2022, from https://www.aarp.org/health/medicare-insurance/info-2022/advantage-claims-denied.html

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