IBM Medicare Via Benefits Extend Health Medicare Advantage Plan Problems

This month the New Yorker  published an article about whistle blowing which featured what happened to two people who, as employees, exposed how Medicare Advantage insurers were manipulating both policy holders and the federal government to maximize corporate profits.  Although it was a profile of the whistle blowers, the author did an excellent job of explaining how some insurers are costing taxpayers billions of dollars and reducing the ability of seniors to get adequate healthcare.

The New Yorker article closely paralleled a PBS broadcast several months ago in the area of explaining how insurers are manipulating costs to maximize profits but the PBS broadcast did not include much about what happens to whistle blowers (that alone is worth the read). It's no wonder employees don't whistle blow on corporations. It ruins people's lives.

Here is a link to the New Yorker article:
https://www.newyorker.com/magazine/2019/02/04/the-personal-toll-of-whistle-blowing

Here is a link to the PBS program:
 https://www.pbs.org/video/medicare-advantage-taking-advantage-aldeae/

Some of how the fraudulent actions affect policy holders is buried in the New Yorker article.  There was a description of a practice called "lemon dropping" which is a practice these insurers use to get rid of the sickest policy holders. They were doing it by paying incentives to insurance sales agents to convince people to switch to a different insurance company if they noticed the claim payout was high.

Based on recent counseling sessions, I suspect the "lemon dropping" strategy is being practiced a new way.  Medicare Advantage insurers seem to more frequently deny seniors access to healthcare procedures and  rehabilitation, particular after a hospital stay, by denying coverage for procedures the insurer say are not medically necessary.  Rehabilitation is a costly payout benefit to the insurers.  If denied, a policy holder has to go through a arduous process of appealing the denial and some just don't have the wherewithal to do it after being hospitalized. If they don't have relatives or friends who will vigorously fight the claim denial, they end up being discharged in a compromised condition.  It is likely intended to make the lemon (aka expensive reimbursement) policy holder angry enough to get them to switch to a different insurer, but if the policy holder dies the lemon also drops.

Once again, I urge anyone considering a Medicare Advantage plan to do it "eyes wide open".

Update May 2019:

Kaiser Foundation did an analysis of doctor networks for Medicare Advantage plans.  It is the first time such a study has been done.

https://www.kff.org/report-section/medicare-advantage-how-robust-are-plans-physician-networks-report/