UnitedHealthcare, CVS Health and Humana had the highest denial rates for long-term care requests, according to a report from the agency’s inspector general.
Patients enrolled in some of the nation’s largest Medicare Advantage plans were denied requests for rehabilitation and other critical services at unusually high rates, according to a report released Thursday by the Department of Health and Human Services’ inspector general./
“These denial rates are quite staggering,” said Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh. “It’s another data point that reinforces what a lot of Americans have already been articulating a lot of frustration about — which is that healthcare decisions are being made with profit rather than medical necessity in mind.”
Nothing new.
Over 30 years ago was involved in a total hip replacement on a 45 y/o that my orthopedic friend said he had been arguing with the insurance company for close to a year. Their main pushback was the patient was too young to need hip replacement. His rebuttal/documentation/etc was that she suffered a hip/pelvic fracture 20 years ago that resulted in an accelerated rate of deterioration.
Rising health care costs are a concern for Medicare. Costs are rising faster than inflation. Last year Medicare cost increased faster than Social Security inflation increase. Resulting in reduced SS check.
Imagine what happens when Medicare consumes your SS payment. And we are looking at 20% benefit cut in SS in 6 years.
Trimming health care costs is a good idea. Cutting unnecessary testing. Negotiated drug costs. We should do more.
Everyone wants better healthcare as long as someone else pays for it. When you have to pay for it maybe choices can be made.
Failure of the system would be disaster. We cannot let Medicare collapse.
That is very problematic. Insurance privately or publicly run is a pooling of risk activity.
I worry about such statements “someone else pays” as planted information to chop away the social contract. There are infantile males in particular who like to screw people over in our society.
We say all sorts of things all day long that come from elsewhere.
The hom fool interupt sapien sapien was among 9 humanoids. We may have survived because we copy each other the best.
Yesterday over lunch we had a discussion about this with my in-laws. They recently moved to an independent living place near us and one evening at dinner, a couple at their table were extolling the virtues of their medicare advantage plan … “we never pay anything, not a penny”. Now, my in-laws have regular medicare with part J (I think that is the one, and it costs them about an extra $450/mo for each of them) that covers quite a lot including foreign medical expenses. We told them that under no circumstances should they ever be tempted to switch to any medicare advantage plan. Not only because they are subpar, but because they will have a harder time finding doctors who accept it.
It depends, in some markets Private Equity has bought up a significant portion of all the doctor’s practices and may only accept Medicare Advantage – especially for Primary Care. I even had one MRI place (an Open MRI franchise) near my home tell me that they didn’t accept traditional Medicare and they referred me to an Open MRI franchise 30 miles away in Oregon. I can only assume that Open MRI allows franchise operators to make a conscientious objection to “socialized medicine”. {{ LOL }} Medicare Advantage doesn’t pay higher reimbursements than traditional Medicare and often will make operators wait months for reimbursement.