Today I received an email from a friend in another CCRC who has need of a steroid injection for a very painful bulging low back disc and a facet joint cyst. Coverage was turned down by Virtix Health, a Medicare contracted reviewing company. I guess we’re in a new world. Thanks to Dr. Oz, Washington is one of those states where specific procedures are being evaluated by artificial intelligence, then quite often rejected for coverage. Here’s the list of conditions and the states involved.
Unfortunately, these reviewing companies are paid by Medicare to review these procedures and receive their compensation from denials. She was told that there is no appeal process when she was denied coverage for her procedure, so I advised her to check with the Washington State Insurance Commissioner.
It should be noted that Medicare Advantage costs the government (taxpayers) 20% more than Original Medicare. The Advantage programs are for-profit and favored by the insurance industry. Original Medicare has a much lower overhead and has patients, not stockholders, first in consideration.
This is just an appaling situation !!!! My god. I am now getting calls from Optumrx,
that a number of my regular medications need further confirmation. And that group that is taking over and deciding whether or not our meds are necessary… WOW !
Thanks for bringing this to our attention.
Linda Wolf
Optumrx is a pharmacy benefit manager that works closely with United Health Care. You may have a Medicare Advantage Plan rather than Original Medicare. At any rate, we can all anticipate more potential denials of care unfortunately–whether in an advantage plan or original.