The good news?
When a Medicare Advantage Patient appeals a decision of denied coverage for a needed test or medication, the decision is overturned more than 80% of the time.
The bad news.
Patients appeal less than one percent of the time.
When you’re turned down for care, insist on an appeal.
Denying care indiscriminately is what insurance companies do.
They just say no to a specific percentage of coverage requests, knowing that only a tiny proportion of the patients will appeal. It’s not just Medicare Advantage, every insurance company does this no matter what they insure.
It’s how they believe they best make money.
Next year most of your medication is going to need a prior authorization before it gets covered, so you can expect this to get even worse.
Don’t be passive.
If you’re Medicare Advantage insurer turns you down for your MRI or your metformin, appeal.
Odds are you’ll win.