Medicare patient wrongly sent to collections in dispute between two UnitedHealth Group entities

[Northeast Agent]

Medicare patient wrongly sent to collections in dispute between two UnitedHealth Group entities

The Minnesota-based insurer said he owed $275. The surgery center in St. Cloud wanted another $3,300. UnitedHealth owns both and is now apologizing.

www.startribune.com

The case raises questions about whether CMS should provide more support and protections for seniors when they’re billed incorrectly, said Gretchen Jacobson, a vice president who studies Medicare issues at the New York-based Commonwealth Fund.

“We don’t have data on the prevalence of the problem, but with a growing share of Medicare beneficiaries enrolling in Medicare Advantage plans, these types of situations may become more common,” Jacobson said.

 

[somarco]

Looking at appeals filed by Advantage enrollees and health care providers between 2014 and 2016, the U.S. Department of Health and Human Services’ Office of Inspector General found that plans overturned 75% of their own denials.

“The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided,” the report says. To make matters worse, enrollees and providers appeal only 1% of denials, the Inspector General found, suggesting that some beneficiaries may be going without needed services or paying out of pocket for care.

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Connecting the dots . . . the cited articles have much in common.

How many beneficiaries are paying out of pocket when the claim should have been paid? And if they don't pay out of pocket, they risk being turned over to collections.