Some commercial health insurers administering Medicare Advantage plans continue to put profits over patient care, routinely delaying and denying critical care for patients and communities, NBC News reports.
Some commercial health insurance companies have long looked for opportunities to deny and delay coverage by abusing prior authorization and automated claims processing to deny millions of claims, while adding billions of dollars in unnecessary costs to our healthcare system.
In fact, these barriers to care have real consequences for patients and healthcare providers. More than eight in 10 nurses say administrative policies by commercial insurers delay patient care, and more than six in 10 patients say they have experienced a commercial insurance-related barrier to care in the past two years.
Now, hospitals and health systems nationwide – especially those in rural communities – are sounding the alarm on unfair commercial insurance practices affecting patients within Medicare Advantage. Policymakers are right to hold commercial health insurance companies accountable for their efforts to deny coverage and delay care, and not allow them to keep barriers in place that threaten patients’ access to treatments and vital care.
In an investigative story headlined “‘Deny, deny, deny’: By rejecting claims, Medicare Advantage plans threaten rural hospitals and patients, say CEOs,” NBC News reports on how Medicare Advantage plans submit inflated bills to the public program and repeatedly refuse to reimburse hospitals for the care they provide:
“Problems are emerging with the plans, however. Last year, a federal audit from 2013 was released showing that 8 of the 10 largest plans had submitted inflated bills to Medicare. As for the quality of care, the Medicare Payment Advisory Commission, a non-partisan agency of Congress, said in a March report that it could not conclude Medicare Advantage plans ‘systematically provide better quality’ over regular Medicare.
“Even worse, because the plans routinely deny coverage for necessary care, they are threatening the existence of struggling rural hospitals nationwide, CEOs of facilities in six states told NBC News. While the number of older Americans who rely on Medicare Advantage in rural areas continues to rise, these denials force the hospitals to eat the increasing costs of care, causing some to close operations and leave residents without access to treatment.”
With more than 600 rural hospitals already at risk of closure, Express Healthcare Management reiterates why the practices of commercial health insurance companies toward Medicare Advantage patients requires “urgent attention”:
“Today, over 31 million Americans are enrolled in these private-sector alternatives to traditional Medicare. Unfortunately, a federal audit has revealed that many of the largest plans have submitted inflated bills to Medicare, raising concerns about their integrity.
“In rural areas, the situation is even more dire. As the number of older Americans relying on Medicare Advantage plans continues to rise, rural hospitals are facing significant challenges. These plans routinely deny coverage for necessary care, leaving hospitals to bear the increasing costs. CEOs of rural nonprofit hospital systems in six states have voiced their concerns, stating that such denials are pushing their facilities toward closure, depriving residents of access to essential treatments.”
Kaiser Family Foundation Health News reports that commercial health insurance companies are often slow to pay or simply do not pay hospitals:
“Medicare Advantage insurers are private companies that contract with the federal government to provide Medicare benefits to seniors in place of traditional Medicare. The plans have become dubious payers for many large and small hospitals, which report the insurers are often slow to pay or don’t pay.”