A recent story from Becker’s Hospital Review offers yet another example of certain Medicare Advantage insurers inappropriately delaying and denying care — at the expense of patients, providers and taxpayers.
Mike Thompson, a healthcare policy analyst and media liaison for the Louisiana Hospital Association, sheds light on how harmful Medicare Advantage plans are negatively affecting patients and the entire healthcare ecosystem in Louisiana. He writes, “Inappropriate denials continue to cause poor outcomes for patients, hospital readmissions and increased waste of taxpayer dollars.”
“Her Father Would Be Walking Today”
As Thompson explains, the Office of Inspector General (OIG) has warned that Medicare Advantage plans “may deny needed care ‘in an attempt to increase their profits.’” In Louisiana, several patients have reported difficulty getting coverage for inpatient rehab services that were recommended by their physicians due to excessive and burdensome prior authorization requirements and insurer refusal to approve needed care.
For example, U.S. Air Force veteran George Carrigan had his doctor-recommended care at an inpatient rehabilitation facility (IRF) denied by Humana after having his leg amputated. Instead of going to an IRF, he was forced to go to a different facility where he later experienced major complications, including a fall that required readmission to the hospital for sepsis and an inability to walk. His daughter said she “believes none of these complications would have happened and that her father would be walking today if Humana had permitted him to receive close medical supervision at an IRF.”
Another patient had a similar experience with their corporate Medicare Advantage insurer denying necessary care at an IRF. William Sercovich, another U.S. Air Force veteran, had his request for IRF services denied multiple times until he suffered two strokes. His daughter said, “We were in the hospital for two weeks longer than we should have been because of denials from the insurance company.”
When Medicare Advantage insurers inappropriately deny doctor-recommended care, patients suffer. The affected patient is hurt directly, and denials and transfer delays contribute to overcrowding emergency departments and unworkable administrative burdens that pile on physicians and hospital staff.
Medicare Advantage Plans Deny Cardiology and Cancer Care for Louisiana Patients
Becker’s also reports that Medicare Advantage plans often deny care for patients who need cardiology and cancer care services. Physicians share that care delays for cancer patients can have significant ramifications for their course of treatment and immediate negative effects.
Baton Rouge oncologist Dr. Michael Castine explained how excessive Medicare Advantage prior authorization and documentation requests have affected his patients’ care: “He mentioned risks for patients with small cell lung cancer, aggressive lymphomas or risks of brain metastasis, warning that ‘a delay of treatment by a week or two might actually change the whole plan.’”
In several instances, the burdensome requirements imposed by Medicare Advantage insurers delayed the high-quality, immediate care that cancer patients urgently needed.
Federal Policymakers Must Address Medicare Advantage Plans’ Harmful Practices
These patient experiences in Louisiana build upon other recent reports of certain corporate insurers abusing the Medicare Advantage program:
- The New York Times recently reported on insurers’ excessive use of prior authorization to restrict care for Medicare Advantage patients.
- The Wall Street Journal revealed that “instead of saving taxpayers money, Medicare Advantage has added tens of billions of dollars in costs” from dubious diagnoses physicians didn’t treat.
- They reported, “In a 2021 report, the inspector general that oversees Medicare found the agency spent billions of dollars based on insurer-driven diagnoses for which patients received no care from doctors.”
- A STAT News investigation found that the largest Medicare Advantage insurer “pressed thousands of its clinicians to use a thinly tested medical device to screen people for artery disease, dramatically boosting payments from the federal government for years even though many of the patients were not sick.”
The Coalition to Strengthen America’s Healthcare is committed to strengthening patient access to 24/7 care.
Corporate insurance companies must be held accountable if they prioritize profits over patients by deliberately delaying and denying care. Federal policymakers must take action to ensure that corporate insurers stop impeding needed access to patient care.