Egregious Behavior By Your Corporation and Immediate Request for a Meeting
Dear Karen Lynch:
We write to you on behalf of Physicians for a National Health Program – NY Metro, New York Progressive Action Network, Cross-union Retirees Organizing Committee, NYC Organization of Public Service Retirees, Citizen Action NY, Be A Hero, Northwest Bronx Community Clergy and Coalition, New York Statewide Senior Action Network, Radical Elders, and ACT UP New York. We are a growing group of organizations and individuals in New York that are incredibly concerned about the increased profiteering of American healthcare by your corporation – especially via the Medicare Advantage (MA) program. Using the MA program, insurance corporations are not only overbilling US taxpayers by up to $140 billion each year, but you are also carrying out severe harms based on your practices – all while you pocket billions of dollars in profits each quarter.
The MA program was sold as a way to cut costs, increase choice, and improve health outcomes: in practice, it has demonstrably achieved the opposite of each of those stated goals. MedPAC consistently highlights the absence of meaningful data supporting claims of improvement; in fact, the Journal of Clinical Oncology released a study in 2022 outlining the adverse outcome for cancer patients on Medicare Advantage. Limited networks do exactly what they are designed to do: reduce the amount of choice available to patients. The large quantity of beneficiaries that choose to sign up for an MA plan (a fact which insurance corporations love to point to as evidence of their quality of care) is in reality rarely a choice at all: lower-income people cannot afford to pay for the Medicare supplement plans that wealthier Medicare beneficiaries overwhelmingly prefer. Moreover, cities and companies are choosing to shift their retirees to privatized MA plans to cut costs – to the dismay of employees who have been promised Traditional Medicare plus Medigap.
Private health insurance corporations denied legitimate claims 18% of the time in MA. For privatized Medicaid, private health insurance corporations denied claims up to 41% of the time. Medical debt is such a problem that the Biden administration announced a proposal to eliminate medical debt from credit reports. The increasing prevalence of prior authorization is seen as a “medical roadblock,” and is being met with growing scrutiny by the general public.
In New York City in particular, public service retirees are dismayed at Aetna CVS Health’s negotiations with Mayor Eric Adams to force retirees onto privatized, for-profit MA plans. For decades, New York City public retirees, including teachers, police officers, sanitation workers, 9/11 first responders and other public servants have been promised healthcare benefits through the trusted Medicare program with a Medigap supplement. This combination is something many have come to rely on, and the unwelcome shift will not only interrupt their current access to care and doctor-patient relationships, but also betrays their decades of service.
Aetna CVS Health’s profiteering of the healthcare of America’s most vulnerable populations is not only shameful, but it is killing people. We demand your corporation take the following steps to remedy the situation:
- Withdraw from Medicare Advantage contract negotiations with the City of New York
- Stop the overbilling of Medicare via the Medicare Advantage program
- Stop the overbilling of state Medicaid plans by corporate managed care
- Stop delaying and denying medical claims. Let doctors make decisions about their patients’ healthcare—not insurance company staffers
- Payback fraudulent overpayments to the Medicare Trust Fund
- Overturn existing denials for treatments supported and recommended by medical professionals and traditional Medicare and state Medicaid plans
- Do not use Artificial Intelligence to evaluate and deny claims
New Yorkers are beyond aggrieved by the way you use our health as a cash cow. We demand your timely response through an agreement to meet with us in-person within the next three months to respond to these concerns and negotiate an in-writing explanation of changes you will make including reversing the specific care and claim denials in the cases we will bring to you in an in-person meeting.
Sincerely,
ACT UP New York
Be A Hero
Citizen Action NY
Cross-union Retirees Organizing Committee
New York City Organization of Public Service Retirees
New York Progressive Action Network
New York Statewide Senior Action Network
Northwest Bronx Community Clergy and Coalition
Physicians for a National Health Program – NY Metro
Radical Elders