Medicare Advantage Plan? Caution! A news post from NAELA states that some MA insurance companies are using computers, not doctors, to tell you how much care you will get. Here’s the note:
Denied by AI: How Medicare Advantage Plans Use Algorithms to Cut Off Care for Older Adults in Need
Health insurance companies have rejected medical claims for as long as they’ve been around. But a STAT investigation found artificial intelligence is now taking their denials to new heights in Medicare Advantage, the taxpayer-funded alternative to traditional Medicare that covers more than 31 million people. Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment. The denials that follow are setting off heated disputes between doctors and insurers, often delaying treatment of seriously ill patients who are neither aware of the algorithms nor able to question their calculations. Older people who spent their lives paying into Medicare, and are now facing amputation, fast-spreading cancers, and other devastating diagnoses, are left to either pay for their care themselves or get by without it. If they disagree, they can file an appeal, and spend months trying to recover their costs, even if they don’t recover from their illnesses. <end>
The article refers to the STAT publication, which is an expensive subscription service.
Moral? If you develop medical conditions that may require expensive care, the time may be now to leave a Medicare Advantage plan and return to traditional Medicare with a Medigap policy. It will likely cost more but your doctor, not an insurance company, will determine what treatment you get.
