Denials in Medicare need probe

According to the Inspector General for the U.S. Department of Health and Human Services, Medicare Advantage plans denied 13% of services requested and 18% of payments requested, during a one-week test in 2019.

Responding to the report, representatives of companies such as Aetna and UnitedHealth said “making health care mistakes one-sixth or one-eighth of the time isn’t so bad.” Imagine if ordinary Pennsylvanians could get away with thinking that way.

What those companies fail to address is the number of people such poor performance can affect. Some of these patients are elderly people with higher risks to whom the denial of preventive care could be deadly.

Medicare Advantage plans were created to streamline patient care, procedures and payment, but it cannot be overlooked that denial of payments means denial of care.

Federal officials charged with enforcing the rules regarding these supplemental plans must understand their purpose. A partnership between King Bureaucracy and its corporate friends may be doing damage to some of those the program is purportedly meant to serve.

With taxpayers flooding to Medicare Advantage, insurance companies have to at least reinstill the pretense that their priority is providing health care.

Keep in mind, this data came from a test only one week long. It is only the beginning of our understanding of how often services or payments are denied by insurance companies.

And it remains likely that some of the denials of services requested are valid and a prudent measure of stewardship of our tax dollars. But we need our legislators to drill down to determine how many of the denials can be justified.

Congress needs to use these numbers as their own starting point for asking a lot of questions.


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