medicare advantage sign

“A 79-year-old man with prostate cancer needed a PET scan, but his Medicare Advantage (MA) plan refused to pay for it,” Cheryl Clark writes over at MedPage Today. “Another M.A. plan denied approval for a wheelchair for a patient with multiple sclerosis and a tibia fracture. Still another enrollee recovering from a stroke found he was ineligible for coverage for physical therapy. The neurosurgeon treating a fourth patient, the late University of Connecticut physics professor and melanoma patient Gary Bent, PhD, referred him for acute rehab after removing a lesion from his brain. But Bent’s M.A. plan intermediary refused, putting him and his wife, Gloria, through a lengthy ordeal. They were told he ‘couldn’t withstand intense therapy,’ she said. He was eventually admitted to a skilled nursing facility, but was discharged from there after about 5 weeks because his M.A. plan discontinued payment, even though it turned out he had bacterial meningitis, she said. Those were among many examples of how M.A. plans have routinely denied coverage for medical services — despite their doctors’ orders and despite Medicare policy that they should be covered — presented Wednesday during a hearing of the Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations. Lawmakers have collected many examples in which M.A. plans are failing beneficiaries, ‘denying or delaying care,’ said committee chair Sen. Richard Blumenthal (D-Conn.) at the start of the hearing. They ‘face denials in the middle of major medical crises, forcing them and their loved ones to fight even as they are fighting for their lives. Perhaps most troubling of all,’ Blumenthal continued, ‘there is growing evidence that insurance companies are relying on algorithms rather than doctors or other clinicians to make decisions to deny patient care.'” Cheryl Clark, “Congress hearing explores Medicare Advantage routines that deny, delay needed care,” MedPage Today.

For more, here’s our “How much does Medicare cost?” handbook on how to approach Medicare.

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...