Rick Timmins, a retiree in Washington State, reports the delays and denials he has faced trying to get care while enrolled in a Medicare Advantage plan in Washington State. The costs of these delays and denials have been substantial and the consequences severe. What’s worse is that he is locked in to Medicare Advantage, no longer able to switch to Traditional Medicare.
Many people join Medicare Advantage when they turn 65 in order to save money on the supplemental coverage that is needed to protect themselves financially in Traditional Medicare. They also often save money on prescription drug coverage, which Medicare Advantage usually covers. What they often don’t realize is that once they’ve been in a Medicare Advantage plan for more than a year, they have no right to buy Medicare supplemental coverage if they want to switch to Traditional Medicare, except in Connecticut, Massachusetts, Maine and New York.
Rick Timmins had a rapidly growing painful lump in his neck. But, his Medicare Advantage plan made him wait five months before it authorized him to see a dermatologist. And, when the dermatologist referred him to a surgeon, the Medicare Advantage plan made him wait an additional two months.
Timmins made countless calls to his Medicare Advantage plan to try to speed up the approval process. But, he could not get a straight answer as to why the prior authorization was taking so long. Customer service could not even find his prior authorization request.
As it turned out, his Medicare Advantage plan had subcontracted the prior authorization to Optum, another company, without telling him. When he finally learned that this is what had happened, his Medicare Advantage plan could not provide him with Optum’s contact information.
The Medicare Advantage plan’s website provided inaccurate information about his claims and out-of-pocket costs. He paid $6,570 out of pocket although his maximum out-of-pocket amount is $6,500. And, the MA plan’s customer service staff could not explain the frequent claims denials for services he received at the cancer center or his financial liability.
As a result of all these delays, his lump, which turned out to be cancerous, grew larger and became a more aggressive tumor. He needed extensive surgery and immunotherapy over the course of a year to treat the cancer. All this additional treatment cost him more physically, financially and emotionally. He had a longer and painful recovery from a partial amputation of his ear and exploratory surgery in his neck.
Timmins would like to switch to Traditional Medicare, but he can’t. Insurers offering supplemental coverage to fill gaps in Traditional Medicare will not sell him a policy. And, he does not have a right to it. He is locked in to Medicare Advantage for the rest of his life.
Here’s more from Just Care:
- Traditional Medicare v. Medicare Advantage? Different as night and day
- Ten ways to improve Medicare Advantage
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Government rules won’t curtail Medicare Advantage bad acts without stiff penalties
- What are your Medicare premium and other costs in 2023?
