Be a Medicare Advantage whistle blower?

At the same time as the state of Illinois switched my Medicare Advantage program for retirees from United Healthcare to Aetna I was being treated for Crohn’s Disease with a very expensive drug.

My drug requires prior authorization in spite of the fact that my gastroenterologist had prescribed it and it is a fully approved treatment for Crohn’s.

Last January 1st my Aetna Medicare Advantage kicked in and I had to get prior authorization once again.

The approval was just for a year and ends December 31. Now I need my GI to request prior authorization for 2024.

As I have argued early and often, Medicare Advantage represents the move to privatize senior health care and destroy Medicare. That’s the big picture. But nothing annoys folks as much as Big Insurance undermining the patient/doctor relationship with demands for prior authorization.

Aetna outsources the their prior authorization requests to a third party called Evicor whose main job is to deny them.

Another annoyance is the onslaught of often fraudulent tv ads and junk mail for dozens of MA plans. They show up every October to December.

That’s when MA has open enrollment.

Now it seems that officials at the Centers for Medicare & Medicaid Services are encouraging us to become Medicare Advantage whistle blowers by reporting misleading or deceptive sales tactics to 800-MEDICARE, the agency’s 24-hour information hotline. Suspects include postcards designed to look like they’re from the government and TV ads with celebrities promising benefits and low fees that are available only to some people in certain counties.

The new rules, which took effect Sept. 30, closes some loopholes in existing requirements by describing what insurers can say in ads and other promotional materials as well as during the enrollment process.

So now, in addition to having to check out my own groceries, the feds want me to do their job of monitoring Big Insurance.

Kaiser Health News reports:

Expecting beneficiaries to monitor insurance company sales pitches is asking a lot, said Semanthie Brooks, a social worker and advocate for older adults in northeast Ohio. She’s been helping people with Medicare sort through their options for nearly two decades.

“I don’t think Medicare beneficiaries should be the police,” she said.

Choosing a Medicare Advantage plan can be daunting. In Ohio, for example, there are 224 Advantage and 21 drug plans to choose from that take effect next year. Eligibility and benefits vary among counties across the state.

“CMS ought to be looking at how they can educate people, so that when they hear about benefits on television, they understand that this is a promotional advertisement and not necessarily a benefit that they can use,” Brooks said. “If you don’t realize that these ads may be fraudulent, then you won’t know to report them.”