31 million people are on Medicare Advantage plans, a private alternative to traditional Medicare. The plans are often cheaper and promise better benefits. However, the CEOs of rural hospital systems in six states told NBC News that Medicare Advantage routinely denies reimbursements for necessary care. NBC News’ Sam Brock reports.
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#MedicareAdvantage #Hospitals #Medicare
This news report sounds like a commercial for Medigap.
Not surprised…
Insurance is a SCAM already . Medicare advantage is a huge scam that takes care of seniors . They never pay claims and the PATIENT ends up responsible. It is better to have MEDICARE PART B and a MEDI-GAP plan as your secondary to cover what costs part B doesn’t cover . Plus with part B as your primary you can go to any PROVIDER and not be tied to one medical group and the freedom to see whoever you want .
I wish I knew which plans were apart of this study. Knowing the road blocks is better than just hearing about it 🤷🏽♀️🍎 thank you for the report
This is called uncontrolled capitalism. Medicare Advantage should be called Medicare Disadvantage. When profit is the name of the game then any care the patients get is incidental to the need for the profit to satisfy shareholders and executive compensation. This report from NBC should have been more detailed with a deeper dive as to why these plans cheat and deceive senior citizens. Whenever I get these deceptive ads that even attempt to look like a letter from original Medicare I shred the information. Private for profit insurance companies cannot compete with non-profit medicare. There have been too many for profit incursions into Medicare already such as Part D. The purpose of medicare is to provide benefits for senior citizens who have paid for Medicare all their work lives and this benefit is not free. We have paid and are still paying for Medicare even while getting social security pension benefits. Just remember for profit companies can never compete with non-profit Medicare. Whatever benefits or promises these for profit companies make are short lived. Even when reading the fine print the contracts are not clear and always written for their profit only. Medical treatment should never be for profit. Physicians, surgeons, and medical technicians should receive compensation for their work but the medical care should not operate as a profit making enterprise to satisfy shareholders.
Well, DUH. Joe Manchin blocked Build Back Better which included the addition of dental, vision, and hearing to Medicare (something most advanced countries already provide to their retirees, and NO, Manchin being “worried about the budget” was no excuse as 60% of our debt is from excessive tax cuts for the wealthy/corporations). I looked into Medicare Advantage as an alternative for my disabled parent but found that it ALWAYS results in less coverage of other benefits/visits/procedures to make up for the additional benefits. It’s basically a con as ALL profit-based healthcare and insurance is.
I’m on a Medicare Advantage PPO plan in Fort Lauderdale, South Florida. We are in a very competitive Medicare Advantage market, but I must say it’s really a company issue, as I’ve lived in areas all over the country, and I just haven’t seen the problem described in my 20 years of being disabled by complex illness. I use in network providers whenever possible but sometimes I even use out of network providers, and I do not get denied for properly requested care. I have belonged to Aetna, Humana, and United Healthcare plans in cities and towns everywhere and they have always acted the same way. The present market I live in is a competitive market and on the Medicare website they get graded by patients for their efforts. I would suggest the hospital management solicit one or more new major companies into the market so your hospital can be paid for care appropriately by that Medicare Advantage plan instead of the ones that presently serve your area. In addition, I would also check to make sure that your claims are being submitted with correct, reimbursable codes for both the care and the diagnoses.
In addition, the government may want to get involved with policy to address rural Medicare Advantage coverage issues so that it doesn’t have to be a competitive marketplace to get great care in rural areas. It’s needed there even more than the cities. Thank you for reading, and very best of luck to you!
Why doesn’t media tell us who in congress is being paid by insurance industry lobbyists? Why don’t they report on the health plans that congress has?
You do know that Congress people have free healthcare for life don’t you? They pay ZERO. EVER. Please tell me why they deserve that? And as they enact laws that directly impact the way insurance does business and OUR care, doesn’t it seem a conflict of interest? Or at the very least a problem they don’t have to ever think about themselves and don’t have much empathy about.
This report is about Medicare Advantage insurance plans which is insurance sold by the insurance companies. Don’t be misled with the slick ads from the insurance companies. Enroll in original Medicare not a Medicare Advantage plan, they are not the same thing.
Lol and we are surprised idiots. They deny longterm care for assitant living for senior citizens.
“Medicare Advantage” takes advantage of seniors. Thanks to Republicans who want to privatize everything, back in 2006, the Bush administration opened up traditional Medicare to “the market”.
For over a century now, Republicans have been out to block anything that helps people while destroying everything good that already works fine, they work to sabotage until they ruin it, because they’re diabolical.
The “party of life” is all about killing *actual* people while pretending to care about *potential* people in the form of fetuses, when it’s just because they hate women having body freedom of reproductive choice.
Thanks for finally doing some investigative reporting. We need MUCH more investigations!
*2:55**. That’s why they call it the ADVANTAGE plan. Thats what they take of you!*
The way to reduce Midicare expenditures is to reduce treatment.
I have United healthcare and Optum through my union. Optum requires pre authorization and still deny deny deny. Although advantage plans take money from our hard earned medicare contributions. It’s all about profit for the advantage plans they don’t care about the people they are suppose to serve. Someone needs to make them accountable.
I was told many years ago to say no to an Advantage plan and yes to a Supplemental plan. I’ve had no problems.
This is critical issue affecting millions of Americans deteriorating their necessary medical care forcing them to suffer despite of their hard working and paying for Medicare entire lives
Oh yes! Infact, in Florida, alot of people don’t know how to utilize the coverage. Well because they don’t make it easy to understand. I was hardly able to move because of my back. My orthopedic dr said I would need to get authorization from the insurance company before I got the mri. More days went by, and Ever Core who contracted with Aetna said NO. I had to appeal, more time went by. This is the 2nd orthopedic I saw because the 1st Dr said I need to go pick up the RX for the prescription and give them a specialist copay, when I couldn’t see the Doctor! I was an All Lines Claims Adjuster and this makes no sense to me! Then that had to go to EverCore and was denied! Why? No idea! You can’t even get ahold of a knowledgeable worker to explain! I have talked to several people at Aetna and got different answers. If you get transferred to offshore customer service, your out of luck. Those women in another country are so nice, but it’s obvious they haven’t had training! Let’s hold these insurance companies to a better standard! All I could do was to contact the State Insurance Commission to help me! Good grief!
How many different ways do you need to prove that the system you’re a slave to is CORRUPT and has almost nothing to do with the patient. Good luck.
If you are denied ,demand an appeal. It is not a healthcare person making that decision.
We have always won on every appeal we made with no problem, whether for a service or medication. Also, watch your doctor’s coding. Often the doctors are making the errors (from a medical family).
Contact your state insurance commisioner for further assistance! Former claims adjuster
Glad I have the public health service in Spain 🇪🇸🇪🇺🌹👍
Medicare Advantage should be illegal
peddling lies to seniors who dont know the system
i handle my hubbys care as i was an adminstrator for a state health agency and i keep him from making mistakes but not everyone has an advocate like me in their corner,,
sad sad,, all lies..;;den of thieves
Apparently, the “Advantage” is for the managers, not the patients with the coverage.
Each Medicare Advantage plan is different. It takes a lot of research to find out what each one covers. They’re not all bad. Get good advice from your state and spend a lot of time comparing. And good luck. You also need that.
They are all bad once you have a lot of complex medical conditions (expensive to treat). At that point they want you on hospice and off their plan.
Exactly! Very location specific. Markets with high numbers of seniors in the population, like Southern California, often have fabulous Medicare Advantage plans and great medical groups within that system. Ours have the best doctors and hospitals as well. Why it is an important consideration when choosing WHERE to retire.
I’m just wondering about the timing of this story. Did it not occur to them to get this out BEFORE open enrollment (when people choose or change their Medicare plans) closed? That was Dec. 7th.WTAF??!!
Have you had your head in the sand all your life? These discussions have been going on for over 15 years. With no disrespect, anyone who is not aware of this situation deserves what they get. Secondary to that is that for the majority of folks, due to the pre-existing conditions clauses, there is no switching to traditional Medicare with a supplement.
@@denali9449 Gee thanks for the kindness. Yes, I guess you could say I’ve had my head in the sand. I’m brand new to Medicare and have had a whole lot of OTHER issues in my life needing my attention. So, I apologize for not knowing everything everywhere all the time. How thoughtless of me.
I wonder if these companies are scamming medicare as well by getting paid a percentage by medicare for the treatment then turning around and denying any coverage of that treatment to the hospital or clinic that preformed it. The reason I am asking is because I live in Illinois and a few years ago the state automatically switched my healthcare from origianal medicare/medicaid to Medicare-Medicaid Alignment Initiative with meridian. Then followup visit with provider that was usually covered i was suddenly billed for in full came in the mail and I had to call around “clinic,new insurence, state aid, medicare” to find out why and get straightened out. It took over a year for “medicare” to be the ones to finally get to the bottom of that and medicare suggested to switch back to original medicare/medicaid for the time being while they investigate what was going on. Because they said they paid their share for that.
so does Medicare. Fake news.
They need to investigate my detainment against my will TWICE since 2019. Upward around $50K taxpayers $ going for unnecessary treatments which are actual illegal holds on innocent people. WAKE UP AMERICA!
Medicare advanage is a scam.
⛔⛔ why is this a SURPRISE! when the CEOs, their executive teams, and investors main priority is PROFITS….your health is LAST! the executive team at Bcbs, United, Cigna, Humana, Kaiser earn BILLIONS in BONUSES every year to deny your procedures. PROFITS PROFITS PROFITS PROFITS! WAKE UP AMERICANS!
I struggled to afford original Medicare the whole first 15 months I had it because I wasn’t yet old enough for my own SS retirement benefits and was struggling on my deceased husband’s SS survivor benefits. Didn’t matter: I pinched pennies and did everything I could to pay for original Medicare, because there was NO WAY I was going to take a Scamvantage policy. Now I’m on my own benefits. It’s a little more comfortable, and I am so glad I made the decision I did, even though I could barely afford it.
I am so glad I opted for original Medicare and a Plan G supplement 3 years ago when I became eligible. I was less than a year out of a cancer diagnosis at the time, and I’d spent so much energy (that I didn’t have to give) on arguing with my pre-Medicare insurance to get the necessary treatments during that time. The day I started my Medicare coverage all of that fighting for care and network and pre-approval nonsense vanished. The premiums and LOW deductible I pay are far less than what I paid for my other insurance, and worth the security of knowing that should the cancer bug bite again, I won’t have to wait or jump through hoops to get the care needed.
Glad to hear that you have good coverage.
When i am elected President, i will institute a system of healthcare choice, … a “public choice”, a “private choice”, and a “personal choice”, and every Citizen will make their choice, and they can switch their choice, and then everyone will have “Available and Affordable Healthcare for All”! 😱😁👍👍🇺🇸
Vote WHEELOCK 2024! The INDEPENDENT Party! America’s party! 😁👍👍🇺🇸
Trump 🇺🇸 2024
Surprise, surprise. The fastest way for insurance to profit off really sick people is to “insure” that their demise is as quick as possible. For profit health insurance is always, always going to be a scam.
How scary is this! And why no one fix that problem? I don’t know maybe the government?😢
It’s all about the money, not about helping the sick people. It’s shameful
I am a disabled RN (had license for 35 years). I also worked doing Medicare assessments for reimbursement for a nursing home rehab program. I got an advantage plan thinking it was a good deal (first red flag) and ended up with leukemia. I ended up with thousands of dollars in bills. When I switched back to regular Medicare, a supplement (now dropped, because I can only be billed for %20 of what Medicare ALLOWS, not the actual hosipital bill), and a part D plan, one of the chemo pills I needed for 20 months was $450/MONTH CO-PAY on the advantage plan…. with part D, it was $0/month. Always shop around during open enrollment… you can find significant differences between Medicare options.
I’ve had no problem with my plan, I couldn’t afford the things without it being on Sadi, if they take it away, they better give us a bigger raise, and not make us pay for everything
The 3 D of the insurance industry Deny, delay and defend!
I tried United Healthcare Nedicare Advantage in 2023….they denied claims for in network provider services….traditional Medicare is now my choice
This is a nightmare!😮
The purpose of both hospitals and insurance companies is to maximize profits. Hospitals and Insurance have this ongoing toxic relationship like a prostitute/trick duo who can’t live without the other
Stay on this it’s more then just this
Geez! I guess we are quite lucky here in Miami Dade county. My Medicare Advantage is a 0 copay per visit and for tier one and two medications, we don’t need a referral to see a specialist, covers the gym, offers transportation and gives us $220 quarterly for over the county meds and supplies. Right now my husband and I are being treated by Mount Sinai primary care physician and specialists.
My mom also has a fab MA plan here in Southern California. The best plans and experiences are in areas with high senior populations where the political clout is great. We have great strong medical groups with the best doctors and hospitals. Has been great experience even with heart surgeries and other comorbidities.
As a healthcare worker I know the BS Pls encourage your family member NOT TO ENROLL to this medicare advantage!!! Stick to regular Medicare!
Unless you live in a high senior population area with great coverage like Southern California! Folks have had over 20 years of terrific and really low cost Medicare Advantage coverage even with heart conditions, autoimmune disorders, etc. They saved a fortune, had great medical care and benefited from vision, dental and hearing coverage as well.
Ask he hospital execs what their total compensation is. I bet its greater than 1 million dollars a year.
STOP CALLING IT MEDICARE
Reading stories here it appears regular medicare is better at least for those that have a lot of care costs. If we could all pool our money into Medicare then have a national insurance instead of private insurers we could all save money. This is not a progressive dream and if pooling your money for Medicare for All insurance is socialist in nature then All private plans pooling smaller amounts of money from policy holders are also socialist on the policy holder part, except on the Corporate Insurance company part it’s pure capitalist. You get less choices with private health care insurance, less actual health care and more insurance out of pocket costs.
This is what you get when you, the insurance industry, has congress in your pocket!
the advantage is only for the business that runs it. zero advantage for the patient.
such a ripoff. a republican idea to privatize medicare.
You could take a toilet full of doo doo and compare it to these plans.
People dont read their plan before they sign up. They just sign up.
I deal with these insurance plans everyday. The patients truly need the services, but constantly having to appeal the insurances decision to stop treatment, when they clearly need it. Beyond frustrating for them.stay on traditional Medicare
Just crap Medicare advantage . Why I have Medicare Medicaid regular i’m afraid to sign up for anything else because they deny a lot of care, and that could be deadly. I had started with a different group years ago just for a short time because I switch back as soon as I found out that none of my doctors were covered even though they said that they were and I was like I don’t think so. I’m going back to my regular, even though it cost to have it.
Patients are no longer important, filing insurance claims is chaotic.
The issue here is the hospital cost and it sick
That’s just like the immigrants say come over here and they don’t have to be vaccinated
Yesssss. Because when you privatize things, it’s about the money, so they deny claims. DUH. Privatize Medicare and we get this. Privatize veteran’s care and we get veterans claims being denied.
It’s a scam… HAS been a scam… and politicians of BOTH parties have been bought and paid for so it can be one of the largest scams of all time.
There is no free lunch. Don’t be lured away from traditional medicare by cheap, worthless trinkets offered by advantage plans! Shame on advantage plans
“Advantage” plan seems to benefit only the provider with ALL of the advantage. I’ll bet the CEO and board members were in hyper-salivation mode whenever the next “sucker” bought into their BS. Be sure and thank your senator and representative for all of the benefits you receive while they fold the bribery checks and put them in their pockets.
I love my Medicare Advantage plan. Had multiple ER visits and stents put in after heart attack and on multiple medications and paid less than 1000$ a year in copays. Do your homework, check the drug formularies and get a good pcp.
Same for my dad and mum. Great MA plans and coverage for little money over 20 years. Hear of poor folks paying astronomical monthly sums for some of those Original Medicare supplement plans!!
It seems that the whole point and purpose of this travesty is to promote a political version of social darwinism, in which those without sufficient assets are marginalized at best, and left to die at worst. the best descriptive of the ‘conservative’ mindset as to healthcare is, ‘Want to be healthy? Have to be wealthy’ or get left behind. The worst part of it, to my mind is the fact that these are benefits that we have paid for- yet some beancounter in some cubicle has the power to decide if you are one of the ‘worthy’ and can access a service that we’ve funded.
Euthanasia
Please look up articles about this hospital system. The reason why they have no admissions is apparently due to their licensure status and requirements as a rural hospital. That designation and requirements is from CMS and not the insurance companies. Everytime I try to link an artice youtube removes it which should worry all of you
Our Government SUCKS
Oblunder Care executive order made it ALL possible for insurance companies to have the POWER to DICTATE and deny. That translated to healthcare.gov
Medicare Advantage is horrible.
So, when she got rid of her medicare advantage plan, what plan did she replace it with. And without penalties, if any?
She went with Original Medicare probably with a Part D drug plan and a supplement plan. If she had prior illnesses, she may have had issues with the underwriting those supplement plans require when you switch back from a Part C MA plan.
Medicare and even medicaid denial denial. Advantage. Why we need universal Healthcare.
Noticed that the map you showed were all red states. Those republicans will do any underhanded thing to dismantle universal healthcare.
THANK YOU THANK YOU THANK YOU for reporting on this!!!! Please continue reporting on it. I’m a medical social worker, I cannot get care, not even equipment like wound vacs, for patients on Humana Medicare, People’s Health, UHC, on and on. They just deny, few facilities will accept them for things like rehab or home health. It’s INSANE. People have to learn to just stay on straight Medicare A & B. It’s worth the extra cost to have the care!! I live in New Orleans, this isn’t just rural hospitals.
I guess I’m not the only one with problems with advantage. I’ve had many ills in past. I’m now using a c Pac that well care keeps denying. Even though I followed all their hoops
Often denials are due to doctors’ offices coding things incorrectly. First call the insurance company asking HOW something should be coded for coverage, then go back and ensure your provider is using proper codes.
Retired school teacher with Blue Cross/Blue Shield Medicare Advantage Plan through the State of Michigan. We were kicked out of Mayo Clinic in Phx. AZ because they don’t take our insurance. 🤬🤬🤬🤬
Why you research before making your yearly choice of MA plans! Didn’t you know about in-network requirements?? Many of newer plans have coverage outside original network area, but you must research.
It’s the Docs who are spreading lies about Advantage plans!! Also you interview one person? Amazing the lies you are telling!!
Sounds like the Advantage plan is taking advantage of their customers
Medicare are nothing but greedy parasitic old boars
Medicare Part D has also been taken over by insurance companies. For 2024 the ALL require us to pay a hefty deductible before the benefits kick in.
I retired from the USPS , I recieved a letter about a new Disadvantage Plan just for USPS employees. So I called to see, guy saud it wss a hoid plan, blah blah. I figured there had to be a catch. So i didnt sign up. I wonder why NBC didnt broadcast this before Dec 7?
Why did you wait until ÀFTER December 7, 2023 to publish this story???
Everyone needs to read “10 Costly Medicare Mistakes You Can’t Afford to Make” to educate yourselves on the system. Much of the problem is because we Americans are clueless about Medicare itself! There also are markets where there are terrific Medicare Advantage plans having good medical groups made up of the best doctors and hospitals. Don’t throw the baby out with the bath water just because SOME MA plans are lousy.
I mean just because you’re a doctor doesn’t that mean that you actually care for people. Where is the sense of doing a good deed fall on being a doctor nowadays.
Universal healthcare is so needed here and has been for decades. Get these greedy insurance companies out of the way and get U.S. citizens the healthcare we all need. It has all the upsides, including a happier, healthier, and more productive society.
Is there a list of Companies that are doing this or is it all of them?
🎉I retired three years ago, didn’t understand the difference in original and advantage insurance until two of my white neighbors explain them to me. I went with the original Medicare and purchase a supplement insurance which is higher but I choose what doctors I want to see and pay nothing out of pocket. Advantage they choose your doctors, it’s okay if you don’t have any underlying conditions you may not be able to see the doctors you were use to seeing.
I work in outpatient physical therapy, and Medicare Advantage Plans routinely deny patients who are in desperate need of care. Really sad that these patients are misled, and have no choice but to do without care while the insurance companies profit on these victims.
Key word is Rural- and add in the UN-said word- Red states. They cut their benefits. These are Not private companies- unless you want to call three of the largest insurance companies in the U.S. private.
I guess that’s why my social worker told me to never get the Medicare advantage
Who in their right mind would buy insurance from a shady ex-football player who, if you didn’t know who he was, you’d swear was a used car salesman?
I just signed up for one. Great!! Gonna call them Monday
We are forced to pay into Medicare from the day we start working and this is what we have to look forward to!!??????
So they take the money from Medicare and tell people it’s free?
What about in big cities? does med. Advantage cover better since there is so much competition?
Advantage tried to get me to switch.. they lied and said they WERE Medicare.. they are all pueces of crap and I’d recommend NEVER switching to anything other then regular Medicare and Medicaid!
It’s a shame we can’t get coverage like those in Congress. I think the taxpayers pay for their coverage. If this is true, this makes me sick.
America eats its own… our new slogan, as The American Dream is dead.
How do you like your government funded care now?
Legal theft agencies. Taking money and NOT allowing services. This is America after all! Jokes on You!