Medicare Advantage plans, which are swiftly growing in popularity among senior citizens, have at times delayed or denied beneficiaries' access to medical care -- even though the requests met Medicare coverage rules, a federal watchdog said.
The report from the inspector general's office of the Department of Health and Human Services is the latest red flag related to inappropriate denials by Medicare Advantage plans, which are run by private health care insurers. Annual federal audits have highlighted"widespread and persistent problems related to inappropriate denials of services and payment," the office said.
In some instances, insurers used clinical criteria not contained in Medicare coverage rules -- such as requiring an X-ray before allowing more advanced imaging, like an MRI. And the insurers ruled in some cases that documentation was not sufficient for approval, even though the inspector general's physician reviewers found that existing medical records were enough to support the necessity of the services.
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