Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds

By Reed Abelson

Federal investigators from the HHS inspector general's office published a report Thursday revealing that each year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program. The investigators uncovered "widespread and persistent problems related to inappropriate denials of services and payment" as they looked into Medicare Advantage plans, which have become increasingly popular among older adults. According to the investigators, about 18% of payments were denied despite meeting all Medicare coverage rules. Rosemary Bartholomew, who led the team of investigators, expressed concern that Medicare Advantage beneficiaries are not receiving the care they need and pointed out that only a small percentage of patients or providers try to appeal the denials. The investigation years of complaints by hospitals and doctors about denial of care and insurance company tactics.

Read more on the New York Times.