[“When I first enrolled in Medicare, I selected a Medicare Advantage plan because it seemed less expensive than traditional Medicare,” Richard Timmins of Freeland, Wash., said in an email. “It was only when I needed care that I encountered the disadvantages of Medicare Advantage, limited networks, requirements for prior approval for almost everything, subsequent delays and denials, and denied payments.”]
An audit done by the government’s inspector general found that Medicare Disadvantage falsely denied 18% of payments that they were supposed to approve and that real medicare would have approved. This amounts to 1.5 million times per year that Americans were shafted by illegal payment denials from those companies. There are also increased hassles and delays in getting your medical care and limited choice of doctors.
[An estimated 18 percent of payment denials met Medicare coverage rules and MAO billing rules and therefore the provider payments should not have been denied by the MAOs. This projects to 28,949 payment denials that met Medicare coverage rules and MAO billing rules for these MAOs during the first week of June 2019.]