WAKE UP about Health Insurance

[RayM920964]

In response to all of the comments about UHC, the fact remains that there has been a continuous pattern of claim denials and increasing profits for this company.

Here are the facts.

1. UHC denies more claims than any other health insurer

2. UHC is a for profit entity and raises their premiums higher because of both health care costs and to increase their profits.

3. UHC also very aware that patients will sometimes need to jump through hoops to challenge a claim denial through legal means which means time and money. It can result an a reversed decision on the claim, but it can be a long, painful process.

4. UHC is using AI algorithms in determining a claim eligibility

5. AARP promotes UHC and receives royalties from them.

You can research everything I stated, along with UHC and their overall profit margin, and come up with a fair and educated understanding of the problem.

Here are possible and ways to address the problem.

1. Write or call your Congressman or Congresswoman. I contact my elected officials often, and I ask them what they plan to about about a specific problem and I follow-up. The more people who get their elected officials involved, the more things will get accomplished.

2. Contact AARP and have them rationalize their continued support of AARP. My own response to AARP is that they need to look for health insurers who better serve its members. Unfortunately, I am taking it a step further and will not renew my AARP membership. They are not looking out for our interests. Plus, I don't need the coupons and the articles they publish that I can find anywhere online.

IT IS TIME TO WAKE UP.

[GailL1]

@RayM920964 

Actually it isn’t just UHC that is doing the prior authorization and the denials or processing the appeals for the denials - it is all of the MA insurers.  

CMS has long been a supporter of utilization management - yes, they also do it in original Medicare as much as they can feasibly do it.  Now they are issuing further rules in how these can be accomplished with the insurers with transparency and simplicity.  They have already initialted some of the changes for 2025 and more will be forthcoming in 2026.  

CMS.gov 11/26/2024 - Press Release - Medicare Advantage and Medicare Part D Prescription Drug Propos... 

CMS and other government health related programs have always supported utilization management.  It is but one way to keep down unnecessary and unapproved treatments.  Has it gotten out of control - it appears so and now it is time for CMS to act and set down specific paths for this process.

from the link: 

In recent years, there have been increasing calls for reforms related to MA prior authorization, utilization management, and coverage decisions. CMS remains concerned about barriers to accessing care and high burden on the system. For example, data reported to CMS by MA plans indicate that, on average, MA plans overturn 80% of their decisions to deny claims when those claims are appealed to the plan. These data also show that less than 4% of denied claims are appealed in the first place, meaning many more denials could potentially be overturned by the plan if they were appealed. Ultimately, what these and other data show is that MA enrollees may not be getting access to the care they need. The proposed rule builds on CMS’ work to remove unnecessary barriers to care resulting from the inappropriate use of prior authorization and internal coverage criteria. The rule would also increase guardrails on the use of artificial intelligence (AI) to protect access to health services. Other proposed policies will promote competition on the things that matter to people enrolled in MA and Part D plans, further addressing misleading marketing practices, and enhancing consumer tools on Medicare.gov. 

Our loved ones with Medicare deserve care that puts their interests first. HHS is proposing to improve transparency, accountability, and consumer protections in Medicare Advantage and Part D plans so that everyone receives high-quality care,” said HHS Secretary Xavier Becerra. “To achieve that, we want to remove barriers that delay care or deny people services and medications they need to be healthy. In addition, we continue to promote competition for pharmacies and other health care businesses.”

So we are gonna have to work together along with the insurers to come up with a plan to control and simplify this procedure.  It’s a fact of life that controls have to be initiated - to insurers and to providers - but which produce best practices.  This isn’t just for MA plans, MAPD plans, or Part D free-standing plans - it is for the entire system including Traditional Medicare.

[jj628]

https://www.levernews.com/why-is-aarp-boosting-medicare-privatization/

[GailL1]

@jj628 

I don’t think the AARP has ever hidden the fact that they make royalties off the use of their branded name.  They don’t endorse any of their vendors that purchased their branded name - although I think many people believe that they do so I guess you could say that it is implied but not legally an endorsement.  

I have been on this social media board since 2008 and I read lots of post where the folks seem to be in the dark about the realities of business relationships.  In fact many are in the dark about how Social Security, Supplemental Security Income and Medicare, or even Medicaid work.  But that isn’t an excuse and people need to spend some time learning about the various government programs work.

BTW, AARP also makes royalties off their AARP/UHC Medigap plans too - and their AARP/Hartford Auto and Home Insurance products.  But still there is no endorsement of any of these.  Although you do have to be a member of the organization to get one of the branded Supplemental plans - well, at least for the specific year when it is purchased.

Do you not think that the AARP Foundation is a good thing?  Actually, that is the advocacy arm of the organization - just like the AARP Services, Inc. is the profit making arm of the organization and is responsible for all these branded deals.  

[RayM920964]

I am confused about the mention of an endorsement versus recommendation.  In some articles about  AARP , there is mention of making endorsements but not specific recommendations. 

For example, google: texasmedicalcareadvisors why does AARP endorse unitedhealthcare 

Even if a reader does not see the word endorsement, the partnership and advertisements between these 2 companies could possibly imply an endorsement. The reader sees the ads every month and on TV. They sometimes place their wholehearted trust in the organization that they think are looking out for their best interest, when in fact, the individual(s) should be doing their own homework.

 (BELOW IS WHAT WAS FOUND ONLINE)

 Yes, AARP endorses UnitedHealthcare for certain insurance products, including AARP Medicare Supplement Insurance Plans and AARP Medicare Advantage plans: 

AARP Medicare Supplement Insurance Plans

AARP endorses these plans, which are insured by UnitedHealthcare Insurance Company. AARP members must enroll in these plans. 

• AARP Medicare Advantage plans

  These plans are available to both AARP members and non-members, and offer additional benefits not covered by Original Medicare. 

AARP is not an insurance company, but it does allow insurance companies to use its name in exchange for a commission. AARP also endorses other insurance products, such as the AARP Life Insurance Program from New York Life and the AARP Auto & Home Insurance Program from The Hartford.

AARP encourages you to consider your needs when selecting products and does not make product recommendations for individuals. AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company,

[SusanM664094]

So, AARP is merely selling it's name and access to it's vast network of over 55 subscribers to healthcare plans in exchange for $$$ without disclaimers as to the efficacy of the product. How Corporate America of them. .  

[GailL1]

@RayM920964 

Where on the vastness of the internet did you find such “endorsements” / “recommendations”?  If it wasn’t directly from the organization of AARP, then who else can speak for them.?

What I find is this:  (and with the links so you can read it directly from the source)

AARP/UHC Medicare Advantage Benefits 

from the link (Disclosure):  

DISCLOSURES

AARP commercial member benefits are provided by third parties, not by AARP or its affiliates. Providers pay a royalty fee to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. Some provider offers are subject to change and may have restrictions.

State Availability

Not available in Alaska or the U.S. territories.

Medicare Advantage Plans

AARP® MEDICARE ADVANTAGE FROM UNITEDHEALTHCARE®

Medicare Advantage plans offer additional benefits not covered by Original Medicare.

Available to AARP members and non-members. Plans and pricing are on the UnitedHealthcare website.

=============

Then there is Medicare Supplemental Insurance 

AARP® MEDICARE SUPPLEMENT FROM UNITEDHEALTHCARE®

Medicare Supplement

Supplemental insurance coverage for those enrolled in Medicare Parts A and B.

Plans and pricing can be found on the UnitedHealthcare website.

You’ll leave AARP and go to the website of a trusted provider. The provider’s terms, conditions, and policies apply.

DISCLOSURES

AARP commercial member benefits are provided by third parties, not by AARP or its affiliates. Providers pay a royalty fee to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. Some provider offers are subject to change and may have restrictions.

AARP/UHC Medicare Supplemental Plans Benefits 

The same is true of other Medicare Eligible plans

AARP/UHC MedicareRx

Then we go thru all the other types of insurance plans which bears the branded name:

AARP.org Membership / Benefits 

with the notation at the bottom of this AARP Insurance Benefits page that reads

SECURE YOUR FAMILY’S FUTURE WITH ACCESS TO AARP INSURANCE BENEFITS

Explore a range of coverage options tailored for AARP members. Enjoy access to insurance products from top companies and personalized coverage for all your family’s needs. AARP is here to help provide you with peace of mind and protection. Explore insurance benefits and request a quote today.

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Good grief AARP even has a branded mobile home insurer for those who might have use for it.