I read somewhere recently that the Medicare Supplement and Medicare Advantage industries are not about healthcare, health, care, healing, or people. They are focused on revenue, profit growth, and stockholder returns. They’re 100% money-focused and 0% people focused. Not necessarily bad if you’re selling AI or automobiles, but somewhat skewed if you’re in the human health care services arena.
Sure, they make it seem like they care, for example—
Check out all the Medicare Advantage commercials that talk about the free services available, presented by personable actors and spokespersons who try to connect with you.
Or review the UnitedHealthcare relationship with AARP, where they gave them $9B (yes, with a ‘B’) to co-brand their Medicare programs with the AARP brand. Seniors, UnitedHealthcare clearly has your best interests at heart.
Or even the use of the word “Medicare” in their offerings implies a connection to traditional Medicare, and that thread is much thinner than the implication.
Which, to me, can be quite confusing and misleading to many seniors.
Clearly, insurance providers make money for their stockholders primarily by—
Up-charging the government for the services (legally, of course), and
Playing the Claim Denial game with people to get them to quit on their legitimate claims.
Again, I read somewhere that UnitedHealthcare denies (15% - +30%) of claims. Of course, depending on the insurance, and of course, UHC denies this, claiming a rate of .5%.
Here’s a broad article across insurers on denial rates. It’s worth a read to understand the full breadth and impact of denials. And here’s a quite frankly scary LinkedIn post about UnitedHealthcare.
For this post, the nightmare for caregivers is #2. If you’re in a caregiving role, you know that time is your most precious commodity. And time with yourself for self-care is particularly elusive. So, bring into that mix your trusted insurance partner denying your claims, so that you must manually go through the appeals process. Well, either you alone, with your doctor, or your doctor alone.
In all cases, it creates—
A delay in receiving necessary care,
A time black hole,
And fear for the caregiver (and caregivee if they’re aware of the impact) that their loved one won’t get the care they need.
And that is IF you appeal. Studies show that the majority don’t.
Is it cruel, inhumane, and misaligned with the notion of “healthcare?”
YES!
But that seems to be the intent of the system (if you measure intent by their behavior). But I want to turn the mess around a bit and introduce you to someone who can help you navigate the claim denial process more effectively. Not only you, but also your supporting physicians.
counterforce health
Counterforce Health is a company that has created AI that can help you battle and win in the claim denial process. I’ve previously posted about one of its founders, Neil Shah, who also founded CareYaYa.
Here are a few informational links I highly recommend you follow up on and add Counterforce Health to your caregiving toolbox!
Oh, and a final point…Claim Denials are coming to base Medicare
https://healthcareuncovered.substack.com/p/cms-barrels-ahead-with-wiser-providers
