From NASGA–Advantage plan troubles continue…

From NASGA–Advantage plan troubles continue… by jmdenison National Association to Stop Guardian Abuse Minnesota wants CMS to investigate Humana’s Medicare Advantage plans Posted: 16 Jan 2014 09:10 AM PST   Minnesota Attorney General Lori Swanson is asking the CMS to investigate Medicare Advantage plans offered by Humana and has presented regulators with more than 25 affidavits of complaints from beneficiaries. 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. The letter also 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   Right now Sylvia Rudek is fighting her own battles with Mediacare Humana Advantage plan in ND Illinois federal court.  We have not heard back on Human's/OLR's motion to dismiss, but as usual, first they argue they are "federal officers" to get into federal court, then they have "federal immunity" so they don't have to pay for the damage and trauma caused by delaying stroke rehab to her severely debilitated father by 21 days, causing permanent damage and trauma.  Humana says it's not responsible.  They threw about 50+ cases at us and after reading them all, I determined all of those cases had to do with no appeal being filed.  Well, Sylvia Rudek, our brave champion of the elderly filed her appeal and won! Let's see what the federal district court judge says. And not only did they take one bite at the apple on a Motion to Dismiss, they took two, arguing their second motion was somehow different from the first when it clearly was not. I hope the court does the right thing. JoAnne jmdenison | January 16, 2014 at 9:24 pm | Categories: Uncategorized | URL:http://wp.me/p209wH-13G Comment    See all comments

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