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U.S. Congress should probe insurance rejections

According to the Inspector General for the U.S. Department of Health and Human Services, Medicare Advantage plans denied 13 percent of services requested and 18 percent of payments requested, during a one-week test in 2019.

Responding to the report, representatives of companies such as Aetna and United Health said “making health care mistakes one-sixth or one-eighth of the time isn’t so bad.”

Imagine if ordinary Ohioans could get away with thinking that way about their job performance or obligations.

What those companies fail to address is the number of people such poor performance can affect. Some of these patients — all of whom have friends and family worried on their behalf — are elderly people with higher risks to whom the denial of preventive care could be deadly. Medicare Advantage plans were created to streamline patient care, procedures and payment, but it cannot be overlooked that the denial of payments means the denial of that care.

Federal officials charged with enforcing the rules regarding these supplemental plans must understand that if the are not fulfilling their purpose, they are simply wasting taxpayer dollars. A partnership between King Bureaucracy and its corporate friends is doing damage to some of those the program is purportedly meant to serve.

“Over the past decades, Medicare payment policy for plans has shifted from one that produced savings to one that focused more on expanding access to private plans and providing extra benefits to Medicare private plan enrollees across the country,” said a Kaiser Family Foundation report.

With taxpayers flooding to Medicare Advantage, insurance companies have to at least reinstill the pretense that their priority is providing health care.

Keep in mind, this data came from a test only one week long. It is only the beginning of our understanding of how often services or payments are improperly denied by insurance companies.

Congress needs to use these numbers as their own starting point for asking a LOT of questions.

editorial@tribtoday.com

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