Problems With Medicare Health Insurance Companies – Denied Claims And Deceptive Marketing Biggest Issues

Problems With Medicare Health Insurance Companies – Denied Claims And Deceptive Marketing Biggest Issues

Johnson Sings Medicare Bill 1965
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(Best Syndication) A recent federal audit has revealed that private insurance companies have been denying legitimate claims to Medicare recipients and put into practice deceptive marketing. Since March, 11th, health insurance companies have also been fined more than $770,000 for issues involving Medicare recipients.

This revelation comes at a time when health insurance companies are under scrutiny for claim denials in their non-Medicare programs. The New York Times reviewed 91 audit reports and found a huge backlog “of claims and complaints”. The report also describes “improper termination of coverage for people with H.I.V. and AIDS.”

It is common practice for health insurance companies to change their plan benefits. Medicare officials say that three of the largest health insurance company participants in the Medicare market, UnitedHealth, Humana and WellPoint, have failed to give “timely” notice to their policyholders of those changes.

There are other problems. The report states that the health insurance companies have delayed access to urgently needed medications. They called the violation widespread and “could directly affect the health of patients”.

But it gets worse. Back in July, Medicare terminated its contract with a company in Florida. This left 11,000 residents without any health coverage.

There are problems with the new Medicare Part D drug coverage program as well. Robert Pear of the Times reports that the same abuses are involved in the new drug program.

There are also problems with the Medicare Advantage program, which provides doctor’s visits and hospital care. These plans have grown from 4.7 million participants in 2003 to more than 8 million today.

There were two common problem areas: Marketing and the way the companies handled their appeals. The deceptive marketing problems were most prevalent in the Medicare Advantage products. The problems were so widespread that in June the seven largest companies involved in the program, suspended sales of Advantage programs.

The Times gave some examples of problems with specific health insurance companies. UnitedHealth had to make changes after it was found that they denied claims without any explanation. WellPoint had a backlog of approximately 354,000 claims. Sierra Health Services “ended drug coverage for more than 2,300 Medicare beneficiaries with H.I.V./AIDS”.

Humana had complaints about their marketing. Also, the company did not always tell the beneficiaries about changes in their drug coverage.

Sterling Life Insurance had a problem paying claims. The company “demonstrated pattern of failure,” according to the report.

Health care costs have been escalating over the past decade. The Government Accountability Office (GAO) lists Medicare as a "high-risk" government program in need of reform, in part because of its vulnerability to fraud and partly because of its long-term financial problems.

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By Dan Wilson
Best Syndication News Writer

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