HealthPartners leaving UnitedHealthcare's Medicare Advantage network over high claim denial rate

[progree]

HealthPartners leaving UnitedHealthcare's Medicare Advantage network over high claim denial rate, 7/23/24

HealthPartners announced Tuesday that it will no longer be part of UnitedHealthcare's Medicare Advantage network starting next year.

The nonprofit healthcare organization says it made the decision because "UnitedHealthcare delays and denies approval of payment for our patients' Medicare Advantage claims at a rate unlike any other insurer in our market." HealthParnters claims its denial rate with UnitedHealthcare has been up to 10 times higher than that of other insurers it works with.

The change applies to care provided at HealthPartners and Park Nicollet clinics and hospitals, including Methodist, Regions and Lakeview hospitals. ((These are all Twin Cities or near Twin Cities locations -Progree))

Last week, 11 people were arrested outside the UnitedHealthcare headquarters in Minnetonka for protesting what they allege is the company's practice of not paying for care.

MORE: https://www.msn.com/en-us/money/insurance/healthpartners-leaving-unitedhealthcare-s-medicare-advantage-network-over-high-claim-denial-rate/ar-BB1qwfgE

[Irish_Dem]

1. United Health Care has a long history of ripping off their insureds.

[mucifer]

2. I don't think any health care agency doesn't thrive on denying health care.

[Irish_Dem]

4. They violate their own written contracts.

They would promise insureds a certain number of covered mental health sessions.
They refuse to honor that agreement.

[Lonestarblue]

3. Medicare Advantage gives all advantages to the insurer and few to patients.

It is an insurance ripoff that aims to take over and privatize original Medicare so that insurers call the shots, not the government.

[question everything]

5. I don't understand this. These two are discrete organizations, I thought, each offering health insurance

I never understood why AARP has been promoting UnitedHealth.

It is listed on the Stock Exchange meaning its first responsibility is to its shareholders, not to subscribers. The CEO is handsomely rewarded with multimillion compensation.

And, by the way, HealthPartners also offers Advantage plan. It has been covering all claims.

[progree]

6. I was surprised too. I had Health Partners *insurance* when I was on the ACA in my pre-Medicare days

Now I'm on the AARP United Healthcare Medicare SUPPLEMENT plan (aka Medigap). As I understand it, all supplement plans have to cover everything traditional Medicare covers, and there are very tight rules on the various copays and deductible amounts that are covered with each of the plans. https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits

(Minnesota is one of 3 states that has a different set of supplement plans than the above. I got the most comprehensive expensive one).

I got the plan within 6 months of Medicare eligibility (I don't have the exact window details handy) which means I didn't have to answer (nor was asked) medical questions or have a physical or other medical examination to get it.

But if I try to switch, another provider of supplement plans can base the premiums on my medical history and exam results. Or refuse to cover me. So I'm stuck on it for life.

I wasn't wow'd by AARP's endorsement (nor swayed by it in the slightest). I did a *lot* of research on what was available to me at the time, knowing that it was a multi-multi-year decision..

[question everything]

8. As far as I know Medicare enrollment is not dependent on medical conditions, except for kidney functions

You may want to check during open enrollment October - December.

Spouse has HeaithPartners and I have UCare. Both advantage - at least we do not get separate reports from Medicare - and we’ve never had any problems with either processing claims.

[progree]

9. It's strictly a Medicare SUPPLEMENT (Medigap) thing. The 6-month Medigap open enrollment period is once in a lifetime

Last edited Wed Jul 24, 2024, 04:35 PM - Edit history (1)

Here's what it said when I said I am turning 65 --
https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This is the 6-month period that starts the first day of the month you're 65 or older and signed up for Part B. After this period, your options to buy a Medigap policy may be limited and the policy may cost more.

https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy

Get ready to buy
Your Medigap Open Enrollment Period

Under federal law, you get a 6 month Medigap Open Enrollment Period. It starts the first month you have Medicare Part B and you’re 65 or older. During this time, you:

* Can enroll in any Medigap policy.

* Will generally get better prices and more choices among policies.

* You can buy any Medigap policy sold in your state. An insurance company can’t use medical underwriting to decide whether to accept your application - they can’t deny you coverage due to pre-existing health problems.

* Can avoid or shorten waiting periods for a pre-existing condition if you buy a Medigap policy to replace creditable coverage. How do I know if I have creditable coverage?

After this period, you may not be able to buy a Medigap policy, or it may cost more. Your Medigap Open Enrollment Period is a one-time enrollment period. It doesn’t repeat every year, like the Medicare Open Enrollment Period.

Generally, your Medigap policy will begin the first of the month after you apply, but you can decide when you want it to start.

Graphic explaining how the Medigap Open Enrollment period works, including when it starts, how long it lasts, and when it ends.
View this image in Spanish.

What if I miss my Medigap Open Enrollment Period?
Outside of your Medigap Open Enrollment Period:

* You may have to pay more for a policy.

* Fewer policy options may be available to you.

* The insurance company is allowed to deny you a policy if you don’t meet their medical underwriting requirements.

There are certain situations where you may be able to buy a Medigap policy outside of your Medigap Open Enrollment Period. Situations where an insurance company can’t deny you a Medigap policy are called “guaranteed issue rights” or “Medigap protections.” What are guaranteed issue rights? ((this is a popup with numerous situations. For example one has a right to try Medicare Advantage for up to 12 months -Progree))

Check with your State Insurance Department to see if you can buy a Medigap policy outside of your Medigap Open Enrollment Period. You may have additional rights under state law.

All emphasis mine.

This is extremely very important information for people to know. People need to understand that they really really need to understand Medicare when they sign up (and when to sign up) and not wing it, thinking well I'll just sign up for something like a cheap or no premium Medicare Advantage plan, or riverboat gamble by just getting original Medicare (i.e. parts A and B with no supplement) and then learn more about it when I have time. Nope.

I have more on other issues with Medicare Supplement (Medigap) plans
https://www.democraticunderground.com/?com=view_post&forum=1142&pid=20175

People are amazed that Medicare is this tricky, treacherous, and complicated. But that's what happens when legislation is made the same way that sausage is made. To be clear, I love Medicare, but it's not the nearly free seamless program that many imagine it to be. I'm paying $505 / month combined in premiums for Part B, the Supplement, and a Part D drug plan combined, so it certainly isn't low cost.

[dflprincess]

11. I plan to finally retire next year and will be giving up a very good employer plan

that costs me less than the Medicare B premium (alone) will & covers a lot more. It's the main reason I've kept working, but I just can't stand it anymore.

I'm sticking with tradidtional Medicare but am suffering some sticker shock as I've priced it out what "B" and a supplement will cost. - I haven't added the Part D policy in yet.

[progree]

13. Part D - I'm only paying $41/mo on that

But unlike the Supplement (Medigap), I didn't shop long. i don't take any medications (but I probably should), so I didn't carefully compare formularies or anything like that. Just so I had something that didn't look too bad and covered a couple of things I might need. Something so I don't have to pay a penalty for signing up for Part D months or years later when I need it.

The late signup penalty may seem small, but the math is that it's better to buy some minimal plan even if one doesn't use it, for example, than to skip part D coverage until one needs it -- if one expects to live their life expectancy (or somewhat less than their life expectancy -- it's a long time since I did the math and found the breakeven point and posted about it).

The thing is, that penalty, though seemingly small, is life-long, a certain amount a month until one dies. Which seems strange when one only skipped the first year or two, but that's the way it is. (The per month penalty is proportional to the length of time one went without Part D coverage, but it is a lifelong penalty -- a surcharge to what one pays for Part D)

LOTS OF EDITS / MORE INFO

[dflprincess]

14. I don't think my Part D will be too bad

I only take a couple pretty common generic prescriptions. But, like you, I'm signing up for one so I don't get penalized later.

[dflprincess]

17. The issue isn't reimbursement rates

it's that UHC denies too many claims. They do this with their employer and individual plans as well.

[dflprincess]

10. It's the HealthPartners hospital & clinics that will no longer accept UHC's Medicare Advantage plans

HealthPartners does offer both Medicare supplements & Advantages plans, but their clinics accept insurance from a lot of different companies.

[Silent Type]

7. Odds are, they'll work something out by end of year.

[dflprincess]

12. Only if UHC decides to start paying claims.

Not sure why they'd change their ways now.

When I worked there (20+ years ago). The Onion published and article saying that UnitedHealth Group had decide to try something new: "Will start paying claims". The article had remarks attirbuted to Dr. Bill McGuire who was the CEO at the time. The artcle was making it aound the company like wildfire - even after McGuire's office sent out a warning that anyone caught forwarding it would be fired. (Seriously, he did that, which only made people who hadn't seen the article, go looking for it.)

[Silent Type]

16. My guess is that the docs and hospitals want more money and less hassles. They'll come to an agreement.

They’ll come up with some medical necessity guidelines and pump up reimbursement rates. Almost always happens.

[progree]

15. Hospitals Leave Medicare Advantage Networks as Problems Plague Coverage - about Humana's MA plan being rejected

as well as the United Healthcare MA plan discussed in the OP.

Newsweek, 7/24/24

https://www.msn.com/en-us/money/insurance/hospitals-leave-medicare-advantage-networks-as-problems-plague-coverage/ar-BB1qzmah

Humana's Medicare Advantage plans will also no longer be accepted as in-network options at Aultman facilities in Ohio. ((much more about this later in the article -Progree))

... HealthPartners Blocks Medicare Advantage

((blah blah about the stuff in the OP of HealthPartners leaving UnitedHealthcare's Medicare Advantage network - Progree))

The [HealthPartners] hospital operator also previously dropped Humana's Medicare Advantage plans from its network of covered insurers.

...

For 2024, the Centers for Medicare & Medicaid Services issued a new rule increasing Medicare hospital outpatient payment system rates by 3.1 percent, but insurers have been complaining it doesn't cut their patients' needs, leading to issues with payments for the hospitals.

"The payout rate increase being argued by insurance carriers is not enough, and insurance companies are reporting higher utilization which means their members are costing them more," Chris Fong, Medicare specialist and Smile Insurance CEO, told Newsweek.