We’re cancer doctors. Here’s why Medicare Advantage fails America’s elderly.

Last year, countrywide and across disease groups, 79 percent of patients who experienced a delay or denial of coverage paid out of pocket for medication at least sometimes. Unsurprisingly, more than 100 million Americans are in medical debt. 

Of those who appealed between 2019 and 2023, over 80 percent were approved, implying that the initial claims were valid. This game of attrition directly contradicts Medicare Advantage's promise to provide efficient, patient-centered healthcare…

https://thehill.com/opinion/healthcare/5342603-medicare-advantage-failing-elderly-patients/ 

 

New AI tool counters health insurance denials decided by automated algorithms

The lawsuit against them alleged that nH Predict has a 90% error rate, meaning nine out of 10 denials are reversed upon appeal – but that vanishingly few patients (about 0.2%) appeal their denied claims, leading them to pay bills out of pocket or forgo necessary treatment… 

Doctor's offices now have entire departments devoted to processing and appealing prior authorization decisions…

https://www.theguardian.com/us-news/2025/jan/25/health-insurers-ai

‘It’s a death sentence’: US health insurance system is failing, say doctors

"The surgeon was very honest that he only wanted to operate if the tumor was localized, and without the PET scan, he really would not be able to make that decision," said Kunis. "The surgeon and his office, as well as my office, spent hours on the phone. We were speaking to somebody who was sitting at UnitedHealthcare in front of a computer screen who was really not knowledgeable on the underlying medical problem or the test that we are asking for the patient to have."

https://www.theguardian.com/us-news/2025/jan/26/us-health-insurance-system-doctors