Why does AARP Continue to endorse UHC when they have some of the worst denial rates in the industry?

[cjachcinski]

See subject line - UHC seems to have an industry wide high rate of claim denial yet AARP continues to endorse them for their Medicare related products.  Why?

[dhudgins1220]

I have the same question after selecting them for a Part D prescription plan for 2025. United HealthCare has been a nightmare to deal with.  AARP is supposed to work for seniors, but UHC is definitely not a good solution.

[JuliaW77362]

   I have the very same concern.  My personal issue revolves around claims related to the treatment of Lymphedema.   Treatment for Lymphedema was not covered my Medicare until 2024.  I have tried to get compression supplied through my Physical Therapist.  The main supplier that she uses stopped doing business with UHC because their allowed expense was too low. They denied my first claim and appeal.  They are now demanding more medical justification (the prescription from my doctor apparently is not enough) for the second claim.  While the amount of money is not huge, the pattern of this illegal claims denial is maddening. 

So why does AARP endorse them is my question as well.  I just called AARP and the first response I got was to call UHC.  (Trust me, I have done that several times).  They then took a message.  After reading the responses to this tread, I suspect my feedback will fall on deaf ears.

[GailL1]

Here is what Medicare covers per CMS.gov for Lymphedema Compression Treatment Items

Medicare Advantage plans are allowed to cover the least expensive compression treatment.  Can your Physical Therapist order them for you ??  I don’t know but that is not what this link says.  

Per the link ~ Bandages would be furnished if ordered by the physician and the DME Medicare Administrative Contractor would pay for the garments and/or bandaging if determined to be reasonable and necessary for the individual. As mandated by section 1861(mmm)(3) of the Act, items covered under the Medicare Part B benefit for lymphedema compression treatment items must be prescribed by a physician (or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in section 1861(aa)(5) of the Act) to the extent authorized under State law.

So even under Traditional Medicare, a physical therapist would not be able to order them - so get an Rx from your physician.  

Read thru this and your Explanation of Coverage for your MA plan - Your MA plan probably has another DME supplier - talk to your doctor.  

[GailL1]

@cjachcinski 

Per CMS

. . . . . data reported to CMS by MA plans indicate that, on average, MA plans overturn 80% of their decisions to deny claims when those claims are appealed to the plan. These data also show that a low percentage of denied claims are appealed, meaning many more could potentially be overturned by the plan if they were appealed.

That’s one solution for all MA plan denials - there is always a reason for the denial and many times these are not hard to appeal especially if the info is available to the doctor, as it should be -

CMS has always and still does support Utilization management by MA plan providers.  Traditional Medicare can also do this but they tend to do it after the fact sometimes with leaving the beneficiary with a medical bill that isn’t covered - now that really gets attention and appeals are most likely to be filled - so why not just do the same with MA plans - file an appeal.

[cjachcinski]

Thank you for your input; however, and maybe I'm being a hairsplitter here but I'm not asking about appealing denials.  I know about that and have personally experienced it with my MA plan and had it resolved in my favor.  What I'm asking is why AARP lends its name to a company that has twice  the rate of denial (regardless of overturn on appeal) than other MA plans?  Denial and appeal means 'hassle' (dating myself with that word) and I would think AARP would rather not recommend/endorse/support/lend its name to a company that causes its subscribers twice as much hassle...  Just asking....

[cjachcinski]

Still no comment back from AARP on the "hassle" factor being higher with UHC than other providers....

[Cindyintherockies]

I came here to post this same inquiry. I have not had a problem in the two years I’ve had this plan, but as more information is being made available, I’m seriously questioning if I will continue with this plan. I want to hear what AARP has to say. 

[AARPConsumerCare]

@Cindyintherockies  We're happy to hear you're not having problems with your Medicare plan! UnitedHealthcare has been the provider for AARP-branded Medicare plans for more than 25 years. They provide Medicare-related coverage to more Americans than any other insurance company in the country. If you do have any questions, or issues regarding your specific coverage, please reach out to UHC directly at the number on the back of your ID card. Thank you for being a member, we appreciate your support!  Jodee R. 

[ElisabethB304507]

Your reply appears to be intentionally avoiding the question. Do you believe we’re too old to notice? 

[cjachcinski]

Hi Jodee R

I don't think you understood the point of the inquiry; you totally ignored the data that shows that, as an insurance company, UHC has a poor record w/r/t the # of claims

it denies yet AARP is more than happy to continue "endorsing" them by lending your

name to them which (fine print not withstanding) make it look like AARP is 'ok' with UHC's poor claims servicing.  Would be nice if you addressed that in your answer.

Thank you

[Cindyintherockies]

Thank you! I was very disappointed in this non-answer

[GerardV761134]

AARP makes money from marketing “endorsements”. Read the fine print on the advertising material. Not an official “endorsement” by AARP, just allowing the company to use AARP “endorsement” in exchange for paid sponsored advertising (aka money) by companies. I am a healthcare professional with a doctorate degree, and I can attest to the high denial rates by the United Healthcare health insurance company.

[dhudgins1220]

I would think AARP would not want their name used by a company that clearly does not have it's members best interest in mind.

[cjachcinski]

Thank you for your insights; much appreciated.  Now maybe all (or at least those who are bothered by it) AARP members could lobby for the organization to do a better job vetting the outfits they let use their name and not just sell it to the highest bidder.

[cjachcinski]

Am glad I'm not the only one concered about this.  Wonder how many others will need to express a concern before AARP deigns to grace us with a reply

[DonnaF94840]

I agree! Shame on AARP for taking money from seniors to support an insurance company whose only job is to deny our claims as much as possible. Wow! I’ll likely not renew my membership in AARP because of their support of United Healthcare! 

[DianaT790519]

I have been wondering the same thing. I bought UHC medigap for my husband when he went on Medicare because I assumed they were the best due to the aarp endorsement. Now he is stuck with it due to preexisting condition. I also need health insurance until I qualify for Medicare - they have no insurers (surely I am not alone in retiring early). ACA is a joke .$1600 monthly premium is hardly affordable. Seriously underwhelmed with aarp. They make a TON of money from UHC - they no longer have any credibility..

[cjachcinski]

Glad to see a small but steady stream of AARP members with the same or similar concerns about AARP's "endorsement" of UHC.  And still we hear nothing at all from anyone at AARP about their thoughts on the situation.....my membership is paid up for roughly another year...after that not so sure I'll want to stay with an outfit that doesn't seem to care about this matter....

[yc2612]

When I read the recent news on UHC, I immediately thought about AARP, for that's the ONLY health insurance co it endorses (for the past 25 years).  Since AARP is an advocate for seniors, I assume there must be oversight on AARP's part.  However, below is what chatGPT says with my question regarding UHC and AARP, and now I understand why AARP will stand with UHC instead of its members.  And the solution is NOT to quit AARP, as it provides lots of good information, but to quit UHC.

--- below from chatGPT ----

AARP's endorsement of UnitedHealthcare (UHC) is financially significant. In 2022, AARP received approximately $862 million in revenue from UHC alone.

American Commitment

This income is primarily derived from a 4.95% royalty on premiums paid by AARP members enrolled in UHC plans.

Prospect

Overall, AARP's total royalty income from health-related products and services amounted to $1.134 billion, surpassing the $289.3 million collected from member dues.

Prospect

Given this substantial financial relationship, questions have arisen regarding AARP's responsibility to ensure that UHC provides quality services to its members. Critics argue that AARP has a moral obligation to monitor and address any issues related to UHC's treatment of seniors who trust AARP's recommendations. Concerns have been raised about UHC's high rate of claim denials, prompting discussions about AARP's role in safeguarding its members' interests.

AARP Online Community

Despite these concerns, there is no public record of AARP issuing an apology or acknowledgment regarding oversight of UHC's practices. The absence of such a statement has led to further criticism of AARP's commitment to its members' welfare, especially considering the organization's significant financial gains from its partnership with UHC.

[GailL1]

@yc2612 

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. 

SEC.gov - Royalty Agreement December 1999 - AARP / UHC 

Last One:

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.

CMS.gov. Coverage Determination Process 

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.

Medicare.gov - Medicare Advantage Enrollment Periods Described 

[cjachcinski]

The issue is not claim denial per se - it is that UHC's rate of denial is almost twice that of any comparable company.  Appeals work - of course - 80% of the time as you say but you have to go that route twice as often with UHC - hence twice as much aggravation - is that what AARP is all about for those they say they advocate for?

[GailL1]

@cjachcinski 

UnitedHealthcare is the largest provider of Medicare Advantage plans in the United States. In 2024, UnitedHealthcare had the most Medicare Advantage enrollees, with 9.4 million. 

In 2024, more than half (54%) of eligible Medicare beneficiaries – 32.8 million people out of 61.2 million Medicare beneficiaries with both Medicare Parts A and B – are enrolled in Medicare Advantage plans.

That’s almost 1/3 of all beneficiaries that have a MA plan - which is about 50% of all Medicare beneficiaries.  

• Medicare Advantage enrollment is highly concentrated among a small number of firms, with UnitedHealthcare and Humana accounting for nearly half (47%) of all Medicare Advantage enrollees nationwide. In more than a quarter of all U.S. counties (29%; or 931 counties), these two firms account for at least 75 percent of Medicare Advantage enrollment. Since 2017, the market share for UnitedHealthcare and CVS Health has increased (25% to 29% and 8% to 12%, respectively), Humana (18%) and Cigna (2%) have held steady, while other firms’ share of total enrollment has slightly decreased (Blue Cross Blue Shield (BCBS) affiliates, Kaiser Permanente, and Centene). Small firms (which each account for less than 2% of enrollment) have a smaller share of the market in 2024 than in 2017 (19% to 16%).

KFF.org - 08/08/2024 - Medicare Advantage in 2024: Enrollment Update and Key Trends 

The problem with the appeals is they don’t get appealed.  

I am out of power so I have to make it short - the AMA has found that few patients or physicians file an appeal.

AMA.com - Over 80% of prior auth appeals succeed. Why aren’t there more? 

I know that there is a news release from CMS.gov that says basically the same thing.  But I am short of search power now -

EDITED ADD:  CMS.gov - 11/26/2024- Biden-Harris Administration Announces Medicare Advantage and Medicare Part D P...  

Do people know how to file an appeal?  Do their doctors? 

[cjachcinski]

An apology?  That would be something!  I wont hold my breath.  I would at least like to hear from someone at AARP that they would be willing to transparently re-evaluate UHC and report the results to their membership.  Probably asking for too much.

[20newme15]

Thank you for your very informative post. I too immediately thought of AARP's affiliation with UHC when I was made aware of their nefarious practices. I am a lifetime member and staunch supporter of AARP and their lobbying efforts on behalf of seniors, but this doesn't sit well with me at all. I've only recently joined the Medicare ranks, but I chose to go with original Medicare rather than support a big business private insurance company after reading remarks from health care professionals about their total disgust regarding the latter. [See https://www.nytimes.com/2022/11/05/health/medicare-seniors-health.html?unlocked_article_code=1.p04.x... ]