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Medicare, Inc. Part 2: Taxpayers Paid for Care Denied by Insurers

2025/6/7

The Journal.

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Ana Mathews

Chris Weaver

Jessica Mendoza

Tatiana Facio

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Ana Mathews: 作为一名记者，我分析医疗保险优势计划的数据时发现，许多末期患者在生命的最后一年选择退出该计划，转而加入传统的医疗保险。这让我开始思考，这些重病患者是否在医疗保险优势计划中遇到了获得所需护理的障碍。私人保险公司利用预先授权等手段来控制患者可以获得的医疗服务，这可能导致他们无法及时获得必要的护理，特别是在临终关怀方面。我们的调查显示，许多患者在护理院的护理被拒绝，迫使他们自费支付高昂的医疗费用，或者转而寻求传统的医疗保险。 Tatiana Facio: 我的母亲在96岁时摔断了股骨，需要入住护理院进行康复治疗。然而，我们的医疗保险优势计划却拒绝支付护理费用，理由是“不符合医疗必要性”。我感到非常沮丧和无助，因为我知道我的母亲需要这些护理才能康复。经过多次申诉，保险公司只支付了一个半月的护理费用，我们不得不自掏腰包支付了14000美元。最终，我决定将母亲的保险转为传统的医疗保险，这才解决了护理费用的问题。这次经历让我深刻体会到，医疗保险优势计划在关键时刻并不能真正保障患者的权益。

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Some of the sickest Medicare Advantage patients ran into problems getting end-of-life care. Ultimately many patients switched to traditional Medicare), costing taxpayers billions), according to an investigation by the Wall Street Journal). This is one of many Medicare Advantage practices) that is now under government scrutiny. Both Congress) and Medicare agency head Dr. Mehmet Oz) are pushing for reforms to curb tactics that can boost federal payments to private insurers. The Department of Justice is also investigating) major private insurance companies UnitedHealth), Aetna, Elevance Health) and Humana). Jessica Mendoza) discusses the investigations with WSJ’s Anna Wilde Mathews).

**Further Listening: **

-Medicare, Inc. Part 1: How Insurers Make Billions From Medicare)

-A Life-or-Death Insurance Denial)

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Medicare, Inc. Part 2: Taxpayers Paid for Care Denied by Insurers 21:22 Share

The Journal.

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Medicare, Inc. Part 2: Taxpayers Paid for Care Denied by Insurers