Medicare Advantage plans double denial rate with "AI".
"In October, a report from the U.S. Senate Permanent Subcommittee on Investigations showed that the nation’s insurers have been using AI-powered tools to deny some claims from Medicare Advantage plan subscribers.
The report found that UnitedHealthcare’s denial rate for post-acute care — health care needed to transition people out of hospitals and back into their homes — for people with Medicare Advantage plans rose to 22.7% in 2022, from 10.9% in 2020."
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I feel this belongs in personal finance because these programs can cost you a lot of money by making you eat denials and spending time trying to figure out where you can actually use them.
I helped my mother sign up for ORIGINAL Medicare (with a supplement plan to cover the rest) a couple years ago. I had warned her about Medicare "Advantage" (maybe they call it that because it takes Advantage of the elderly), which is essentially a scam that misuses the term Medicare and ends up causing seniors and disabled people to deal with claims denials and networks full of crummy doctors, and terms like there being no care if you travel outside your plan area, unless the insurance company deems it an "emergency".
Most people are better off with an Original Medicare plan. Actual (Original) Medicare pays for anything that's medically appropriate if your doctor says you need it. Most doctors and hospital networks take it. Denials are rare. Appeals are handled relatively fairly.
Medicare "Advantage" is a coupon to an insurance company that replaces real Medicare for you if you choose to go that way, of course you'll choose it if you rely on bad information. Like the literature from the insurance company.
It's not always easy to get rid of it once you realize you've been tricked.
Recently, the local hospital network, the only one in the county my mom lives in, dumped UnitedHealth amusingly enough. Medicare has lowered payments to most of them as of late, citing quality problems, and the entire program is a mess.
The only reason Medicare "Advantage" was created was to scam the government out of big bucks. At the same time they deny things and force you into bad networks full of crummy doctors, they turned around and told the government that the people they covered are really really sick to scam higher payments out of the program.
It's becoming common knowledge to stay away from these, right at the same time that the incoming regime says it wants to take away Real Medicare. The government loves predictable costs, and inflating the wealth of the donor class, so transitioning people, perhaps unwillingly, to Fake Medicare ("Advantage" plans) is a win on both fronts.
Except, on the federal budget it's not a win for the taxpayer, as these plans get the average cost of an Original Medicare enrollee, plus 11%, plus all the money they get for lying to the government and saying you're super sick when you may not be (and they're in the background rationing your healthcare!). The end result of "Advantage" is a loss for taxpayers, and frustration and denied claims for enrollees.
Their usual line is that if you sign up, they'll give you "benefits" that Original Medicare doesn't, like some dental coverage or Silver Sneakers, but this is to pad the marketing literature and get you in. They promise the moon and the stars and frequently leave vulnerable people holding the bag.
If you want a gym membership, they can cost as little as $10 or $15 a month. Having a hospital bill kicked back by a robot will be devastating.
They used to say "death panels", like there was a board of human beings deciding each claim or something, and then it turns out that they turn over these claims, the Medicare "Advantage" plans do, to "machine learning", and a robot with a 50% error rate on what's medically necessary and appropriate, is the one deciding who lives and dies.
