Delays, Denials, Debt and the Growing Privatization of Medicare

Medicare Advantage enrollees report treatment denials and delays in payment, leading to harmful outcomes in healthcare

June 03, 2024 | Source: US Medicare | by Michael Sainato

Jenn Coffey was sick, on several medications, and in and out of the hospital around 2016 when she made a decision that she has come to regret.

Having fought off breast cancer, the former emergency medical technician faced numerous complications, and was diagnosed with two rare diseases: complex regional pain syndrome and small fiber neuropathy.

“I was terrified,” she said. “I went into the hospital as a fully functional EMT and came out in a wheelchair, to go on disability income, and I lost everything. I lost my house, I lost everything.”

Coffey, 52, had been selling her belongings and raising money on GoFundMe to cover her medical care. To make things cheaper, she shifted her disability plan from traditional Medicare – a government-run health insurance program for older and disabled people – to Medicare Advantage, a program under which private health insurers contract with the Medicare program to provide health benefits.

With monthly premiums of $18.50 per month on average, Medicare Advantage often looks like a frugal alternative. However, private insurers keep premiums low by limiting providers and using byzantine cost containment tools such as prior authorization.

For Coffey, switching proved more expensive, as her Medicare Advantage provider, UnitedHealthcare, denied requests to cover treatments, medications and infusions she required.