Private insurance companies offer health insurance plans under the name of Medicare Advantage. The plans cover much. Unfortunately much of what is covered is simply not paid when the companies receive a claim.
The Centers for Medicare and Medicaid Services reported among other things that their audits again revealed that private carriers often rejected claims without even looking at the patients’ medical records.
As for prescription drugs ultimately funded by Federal taxes under Medicare Part D, the Federal officials found that claims were “’inappropriately rejected’” 61 % of the time.
Only one thing seems to stop the bad faith denial of covered claims by private insurance companies under contract for Medicare Advantage coverage. That occurs when, based upon these findings, the Federal government refuses to allow the offending private insurance carriers to sign up any more patients at Federal Taxpayer expense. See Robert Pear, “U.S. Finds Many Failures in Medicare Health Plans” p. A14, col. 5 (New York Times Nat’l ed., Monday, October 13, 2014).
What say the Medicare Advantage companies? Most of the time they do not contest the charges. They just keep on privatizing. Id.
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