Connect
← Return to Insurance denied petscan? All research shows it sb done, what next?
Discussion
Insurance denied petscan? All research shows it sb done, what next?
Blood Cancers & Disorders | Last Active: Jul 27 8:44pm | Replies (29)Comment receiving replies
Medicare Advantage (MA) plans are required by law to cover all services that Medicare does, but they make their own determinations as to what care is "reasonable and necessary". People should be aware that there is definitely an issue with MA plans denying care that Medicare would permit. See, for example, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815743 A couple of years ago, the HHS Office of Inspector General found that MAs "sometimes delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules". https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf
Are they supposed to do that? Nope. Do they do it? Yep. MAs exist to make a profit. Remember that when you decide between original Medicare plus a medigap and an MA.
So why is nothing done about it? Well, insurance companies have lots of money - certainly more than patients or providers - and are not shy about spreading it around.
Replies to "Medicare Advantage (MA) plans are required by law to cover all services that Medicare does, but..."
Some insurance companies are more active deniers for expensive imaging, blood tests (especially genetic testing) and surgeries . Go on search engines such as DuckDuck Go, Startpage, don't use Google or Yahoo.
Ask what Medicare Advantage companies have terrible payment record.
I sell senior insurance and some companies I don't contracting with because of there poor payment rate or denials
Connect
I have been hearing this a lot lately. I go on Medicare next year and am trying to absorb all the info I can to be well prepared to make the right decisions. My friends get great perks on Advantage Plans but I’m learning the plans are not all they’re cracked up to be. 3 different medical billing people have now told me that I will get better service from non-Advantage plans. And they won’t deny me procedures and meds that are being denied to me now by my current health insurance.