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Re: Why does AARP Continue to endorse UHC when they have some of the worst denial rates in the indus


Re: Why does AARP Continue to endorse UHC when they have some of the worst denial rates in the indus

The AARP doesn't just endorse UHC - they have a contract on the licensing deal and it has been going on for a very long time. AARP Services Inc., the profit making arm of AARP is charged for creating these relationships - all of them not just this one.

There is a licensing contract / agreement between them which spells out the details of what each party does and what they get in exchange. The current contract I believe expires in 2025 but they have the option of extending it until 2030 - may have already - I do not know.

Getting out of such a licensing contract is difficult and could be very costly for the AARP.

United Health Group News Release 07/17/2017 - AARP / UHG extend relationship

I think people are blowing this way out of proportion - every insurance company, public or private can deny or question the medical validity of a proposed procedure or claim - there are forms that a doctor / beneficiary can file to appeal this and based on what CMS says those denials that are appealed are approved 80% of the time.

I just think people think that under Medicare, they can just get anything - it does not work that way. Medical Necessity is a proven scientific measure that usually comes after some other medical protocols - doctors know this and their files should reflect this.

Traditional Medicare and Medicare Advantage plan cover the same things - Medicare Advantage is managed care so of course, they check more but that does not mean that Medicare does not when they see and acknowledge it - that's why Medicare has a listing of Coverage Determinations.

Traditional Medicare only covers 80% of the approved Medicare cost - the remaining 20% is on you either with added coverage or a secondary type of insurance.

Medicare Advantage plans cover it all with copays / coinsurance and managed care - most nowadays also cover the prescription drug coverage.

People even before their eligibility for Medicare who had health insurance of one type or another are familiar with managed care plans.

For many Medicare beneficiaries, Medicare Advantage plans are their only choice of coverage because of either pocketbook issues or their classification of Medicare - many states do not allow those under 65 who get Medicare because of a disability to get a Medigap (supplemental) plan and if they do, only certain plans and then they are tremendously expansive.

Medicare Advantage plans were designed by the government - Part C of Medicare - and the Center of Medicare and Medicaid Services are charged with how they work, how they are monitored, how they are paid and their design. CMS.gov initiates the rules of Medicare Advantage plans.

UHC is the biggest insurer in the country for all kinds of insurance and related coverages. Government depends on them to serve the needs of their beneficiaries and if they or any other insurance company does the wrong things, they are investigated and fined if inappropriate behavior exist.

If AARP stopped doing these licensing deals with their approved vendor - under which they do make a lot of money from these licenses - then how will the offset work?

We are only talking about the Medicare Advantage portion here because Medigap policies are not health insurance - they are GAP insurance that protect a beneficiary from a FINANCIAL Catastrophic Medical event.

If you don't like the Medicare Advantage plan you have now - then switch to another - the Medicare Advantage Open Enrollment period is going on right now - 01/01- 03/31 and you can easily switch to another.

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