If ProPublica can't figure out how to appeal an insurance denial of pre-authorization, what are we supposed to do?
Since the state of Illinois moved public school teachers who qualify for a Teacher Retirement System pension from United Healthcare’s Medicare Advantage to Aetna’s Medicare Advantage on January 1st I have been denied coverage four times.
I am not alone.
According to a report by ProPublica:
The insurance industry and its regulators have made it so complicated to file an appeal that only a tiny percentage of patients ever do. For example, less than two-tenths of 1% of patients in Obamacare plans bothered to appeal claims denied in 2021.
I inevitably will receive a message from a reader saying that the problem is Aetna and that I should move to another Medicare Advantage insurer.
But as the ProPublica report describes it, the problem isn’t Aetna versus United Healthcare versus Humana.
The problem is the privatization of Medicare and the dominance of Medicare Advantage programs.
They all make money by denying service to patients and each has a different and complicated system of appeal.
85% of appeals are eventually won by Medicare patients who can successfully navigate the system, but that percentage is meaningless because so few can figure out how to appeal.
A delay in treatment, medical services or medication because authorization is denied is potentially life-threatening.
Congress know this and continues to do nothing about it.