The affidavits allege, for instance, that Humana denied reimbursement for services that it is required to cover for all Medicare beneficiaries—including diagnostic ultrasounds, mammograms and care in a skilled-nursing facility for a stroke patient.
Theletteralso said, among other complaints, that the Louisville, Ky.-based insurer created confusion by not adequately disclosing which providers were in-network and does not comply with required appeals processes.
The complaints come at a time when the popularity of Medicare Advantage plans has been escalating. And Minnesota has the highest percentage of Medicare beneficiaries enrolled in an MA plan, at 49%—compared with 28.8% of beneficiaries nationwide, the letter said. Humana has 17% of the Medicare Advantage market in Minnesota, according to Swanson’s office.
Swanson wrote that she was asking the CMS to pursue an investigation because states do not have the authority to enforce Medicare Advantage plan rules and make benefit determinations.
Full Article and Source:
Minnesota wants CMS to investigate Humana’s Medicare Advantage plans
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A Breach of Trust