Lying by Omission: is this legal everywhere?

[Sherrerd]

@doreen

There’s a difference between Medicare Advantage and a Medicare supplement. Medicare advantage ( also known as Medicare part C) policies bundle doctor, hospital and prescription coverage all together and if you get yours through say UnitedHealthcare, that is who will be approving treatment and making the initial claims decision.

Right, they work differently.

Under Part C, Medicare pays a sponsor a fixed payment. The sponsor then pays for the health care expenses of enrollees. Sponsors are allowed to vary the benefits from those provided by Medicare’s Parts A and B as long as they provide the actuarial equivalent of those programs.

This is wikipedia but it’s merely a (good) summary of what you’ll find in the book that Medicare send out to recipients, each year:
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.medicare.gov/publications/10050-medicare-and-you.pdf

Here’s more on denials of coverage by some Medicare Advantage companies—this is from the well-respected non-profit KFF:

Virtually all enrollees in Medicare Advantage (99%) are required to obtain prior authorization for some services – most commonly, higher cost services, such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy. This contrasts with traditional Medicare, where only a limited set of services require prior authorization.

and

• In 2022, insurers fully or partially denied 3.4 million (7.4%) prior authorization requests. Though insurers approved most prior authorization requests, the share of requests that were denied jumped between 2021 and 2022. The share of all prior authorization requests that were denied increased from 5.7% in 2019, 5.6% in 2020 and 5.8% in 2021 to 7.4% in 2022.

Use of Prior Authorization in Medicare Advantage Exceeded 46 Million Requests in 2022 | KFF.

The Wall Street Journal article from which I quoted up-thread discusses the phenomenon in more detail.