Health Insurance Whistleblower: Medicare Advantage Is "Heist" by Private Firms to Defraud the Public

About 25 years ago I worked in the medical field. There was a woman who came in with some anxiety due to changes that were going on around her life including going to college and the possible divorce of her parents. After talking to her for a bit she had good support systems and she felt better and I'm sorry to go home. When my supervisor found out the insurance she had, a nurse was sent to the parking lot in search of the woman who was then brought back to the hospital. She was then diagnosed with something more serious. She was given antidepressants and anti-anxiety medication but because she had excellent insurance they prescribed some of the newest medicines which were much more expensive and had many more side effects despite not being as efficacious as some of the traditional medications. In short for these medications she received four additional medications that would help mitigate the side effects of these medications for her so-called depression and her so-called anxiety. This is what happens depending on the type of insurance you have. Physicians in the United States are more like businessmen than they are healers.

Insurance companies are only good for two things, collecting premiums and denying claims.

As a home health nurse, advantage programs are an out right scam. Glad to see some focus on these snake oil salesmen!!

This is ONE MILLION PERCENT TRUE! I sold medicare for a few years and once I started learning about how the medciare advantage plans worked, I elected to opt out of selling medicare. I am so glad that finally someone is exposing these plans!

My mom, God rest her soul, got a stage 4 cancer diagnosis. She was on a Medicare Advantage. The doctors she had said they couldn't pin point which exact cancer but wanted to start treatment anyway. I said no, find out what she has. They refused. I got one of the top cancer hospitals in the world to accept her. (ONLY because she did not start any treatment yet)Medicare Advantage denied it. Said they weren't sure about the hospital. I thought it was a big misunderstanding, called the insurance. After pleading, in tears for mom to get to cancer specialists the lady from the Advantage plan had mercy on me when I asked, "What would YOU do if this was YOUR mom?" She said, "Listen hun, it's nothing personal it's profits, this company denies almost everything first time. So people give up. Just appeal it." I asked how long does that take? She said usually about 3 months. I said my mom doesn't have 3 months. I then found out we were in a special enrollment period. Changed her to traditional Medicare, she got into that hospital and beat her cancer. The treatment the other doctors insisted on would not have worked on her type of cancer. She lived another 8 yrs until a more aggressive form of the cancer returned. Long story short: For profit health care is about caring for their profits not your health. Stear clear. Want a gym membership, get one, don't get insurance because they offer free gym membership.

I wish this was on mainstream news this is so important

When insurance decides whether you live or die something extremely wrong is going on. My wife is an RN and the amount of corruption in the insurance and medical community is out of control and they’re killing people 🤬

Working in healthcare at the largest hospital in my state, seeing how often elderly patients get screwed out of needed care by managed Medicare (private insurers) is heartbreaking. Traditional Medicare is the way to go along with supplement insurance. The premiums are higher but knowing that you'll be taken care of when you need it is peace of mind. Don't skimp on your health and if you do, don't be surprised when you get screwed.

I’m so glad this news is now going mainstream. This is criminal! Ralph Nader and guests have been trying to highlight this issue for awhile.

No surprises here. I worked as a sales rep for a company that operated New York State's first Medicare Advantage program. When the plans were first introduced, the programs were far more regulated and could only be operated as a not-for-profit organization. The beginning of the end for Medicare Advantage programs was in 2006, with the passage of the "Medicare Modernization Act," which opened the field to for-profit insurers like Cigna, Humana, Aetna and United Healthcare. The Part D drug program was a massive giveaway to for-profit Insurance companies and the Pharmaceutical and Pharmacy industries. These companies have become fully integrated, owning not only the insurance plans but also pharmacy benefits management, pharmacies and even hospital ownership. It's pure collusion and it does nothing but harm to Medicare-eligible enrollees who are restricted by burdensome rules such as the referral system to see acspecialist, denial of expensive diagnostic imaging services, denial of care necessitated by one's own doctor's orders. In some cases, the benefit is worsevthan what one would have if one hadMedicare only. And dont even get me started on the obscene amounts of profit and/or extravagant salaries for those executives fortunate enough to really rake in compensation that is easly higher than doctors and even hospital administrators. We already have a multi-tier system of death panels in this barbaric country we live in.

That report should make us all angry enough to call our senators & house reps and tell them to end the madness

I agree! I didn’t know about the difference between Medicare and so called Medicare Advantage until last year. I am no longer in an Advantage plan. Very deceptive

The worst part of our health care system has been the insurance companies. They consume the largest part of our health care dollars

My 82 year old mom take no medication but her doctor wants her to come 4 times a year to take a lot of tests, from cognitive to blood. She refuses the 4 times but goes twice. Still too much. He has even suggested she is depressed and needs to take medication. Fortunately she does not fall for it.

A relative worked for a hospital and then an ins co. She said to NEVER get an advantage plan.

I was in the medical billing department. Insurance company's deny 10 claims, process 10 claims. The pattern continues. We were told by a huge well know insurance company to deny 10 claims pay 10 claims. This was one of their department rules. They deny, deny. They know that the denials are the last claims billers work on. They count on you going past the filing limit. Or forget about them.

We need to stop having insurance companies as the middle men and have universal healthcare.

A physician told me once, "Make no mistake health care is a business. "

Very very true. My sister had cancer when enrolled in Kaiser HMO. Co-pays exceeded by far the premiums for a supplemental plan. A scandal, as is AARP sell out

Im a nurse that worked at a insurance company and I always try to educate ppl about this