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Beware Medicare Advantage


Jan Neal, J.D., a C.A.R.E.S. team member and collaborator from ADSS, recently brought to light some of the downsides to Medicare Advantage plans. Jan Neal's article, "Beware Medicare Advantage", focuses on Medicare Advantage plans' increased likelihood to deny claims, the hidden barriers to health care they can represent, and the difficulties associated with their claim-denial appeal processes.


"The investigation by the inspector general found that 13 percent of Medicare Advantage plan denials should have been covered under Medicare. The findings were based on a review by doctors and coding experts of service denials by 15 of the largest Medicare Advantage plans during the first week of June 2019. Extrapolating from their findings, investigators estimate that nearly 85,000 beneficiary requests for medical care — everything from MRIs to skilled nursing facility care — could have been wrongly denied in 2019.
In an even higher proportion of cases, plans are incorrectly refusing to pay claims. Nearly one-fifth of claims that Medicare Advantage plans initially declined to pay were for services that met Medicare coverage and plan billing rules. This translates to an estimated 1.5 million refused payments for all of 2019, which delayed or prevented payments for services that providers had already delivered."

Follow the link to read more of Jan Neal's wonderful article, "Beware Medicare Advantage"

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