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Progressive dog

(7,269 posts)
71. About Medicare and pre-clearance
Sat Dec 7, 2024, 07:32 PM
Saturday
Medicare and Prior Authorization

Medicare rarely requires prior authorizations. However, to contain costs, the Centers for Medicare & Medicaid Services has authorized Medicare to require prior authorizations for certain hospital outpatient procedures, durable medical equipment and pre-approval for inpatient rehabilitation and home health services.

https://health.usnews.com/medicare/articles/medicare-require-prior-authorization

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Thank you for posting this. I tried to read this article on Rawstory but there is a paywall. OMGWTF Saturday #1
Try this: Ocelot II Saturday #3
I don't particularly like RawStory as a source. Here is the original. ... aggiesal Sunday #85
Thank you. I seldom, if ever, click on a Raw Story link, except dmr Sunday #99
I don't understand why they are allowed to call it a Medicare plan. It should be called privatized senior insurance. Walleye Saturday #2
Technically the Advantage plans offer the same level of service as Original Abnredleg Saturday #5
Yep, my advice is stick with it, maybe get a supplement if it looks feasible, but not a Medicare advantage Walleye Saturday #6
You will also need a DownriverDem Saturday #29
Yep, I'm afraid so Walleye Saturday #35
There are some plans with no premiums up front SCantiGOP Saturday #63
Out of pocket expenses for plan d are now capped at 2000 Voltaire2 Sunday #106
I am 81 and have used only real Medicate, including through cancer treatments for Trust_Reality Saturday #8
The problem is Medicare Advantage plans are allowed to interpret and decide - and they have the final say dalton99a Saturday #9
Are you eligible for Tricare for Life? COL Mustard Saturday #16
I can't say enough good things about the combination of Medicare and Tricare for Life Susan Calvin Saturday #74
I'm still working COL Mustard Saturday #77
Get a supplemental plan that covers the other 20 percent Desert grandma Sunday #90
Because it is literally authorized and governed by Part C of the Medicare statute. Ms. Toad Saturday #81
Do any other private insurers get that part C label? leftstreet Wednesday #148
If Congress passes specific legislation authorizing a Medicare W, and the president signs it, then yes they would. MichMan Wednesday #154
Thx leftstreet Wednesday #155
All private insurers whose plans comply with the Medicare Part C rules (as an alternative to original Medicare) Ms. Toad 17 hrs ago #163
There is coverage as long as you are profitable dalton99a Saturday #4
Wow. ShazzieB Saturday #67
Not quite accurate to say that: "(regular) Medicare always pays". Occasionally they don't. marybourg Saturday #7
It's Not Accurate RobinA Saturday #83
Link to Thom Hartmann's original article erronis Saturday #10
Thank you for posting the original, Erronis Bumbles Saturday #17
Hartmann's post very helpfully supplied by another DUer erronis Saturday #18
And we are forced to have it... Quanto Magnus Saturday #11
And for people over the holidays meeting relatives markodochartaigh Saturday #12
someone has to pay for the 24/7 tv commercials, the annoying calls, and the mailings rampartd Sunday #126
80/20 rule kkmarie Sunday #130
Maybe there is a loophole markodochartaigh Sunday #134
I had a Medicare plan with a UHC supplemental plan for several years Erda Saturday #13
Glad you have had a good experience with an "Advantage" plan. erronis Saturday #20
My elderly mother had the same BuddhaGirl Saturday #23
Miledigap plans are good. That's different from Medicare Advantage. Beck23 Saturday #27
bingo.... markie Sunday #108
My mother has Humana Advantage. SamKnause Saturday #28
100! Wow!! CrispyQ Saturday #46
I'm very happy with my Kaiser Advantage plan. CrispyQ Saturday #32
Wish I had Kaiser here. When I lived in Atlanta, I had Kaiser. They really pushed you to get preventive exams, vaccines, Silent Type Saturday #36
I have Kaiser Senior Advantage and have been happy with it. Both my parents also had Kaiser skylucy Saturday #78
Don't get cancer Henry203 Saturday #42
My spouse has had a good experience with UHC Advantage thru AARP. Beartracks Saturday #60
K&R SheltieLover Saturday #14
It's confusing as hell. milestogo Saturday #15
No, I get tons of emails from CMS/Medicare to look at my open-enrollment options erronis Saturday #21
Another advantage over boonecreek Saturday #19
Medicare advantage plans are all scams LetMyPeopleVote Saturday #22
Advantage plans have networks, either HMO's or PPO's dlk Saturday #24
Original Medicare will not deny treatment Beck23 Saturday #25
Absolutely false. See post #26. Silent Type Saturday #37
Where the fuck do people get this idea? OilemFirchen Saturday #54
My wife's cancer treatment Henry203 Sunday #113
First off, Clinton signed legislation for Part C. And it is not true that Medicare pays for anything a doctor Silent Type Saturday #26
I started buying insurance in 2001. It was horrific. My daughter had to have extensive Henry203 Saturday #47
It's all going to change DownriverDem Saturday #30
I had a bad experience with my mom's Medicare Advantage plan with Aetna. yardwork Saturday #31
Some doctors don't accept Medicare DavidDvorkin Saturday #33
Never heard of any doctor refusing Medicare. Emile Saturday #56
My wife's DavidDvorkin Saturday #69
If you say so. Emile Saturday #75
Normally Henry203 Sunday #116
It's the doctor she had been going to for years DavidDvorkin Sunday #124
If you look at the stat's Henry203 Sunday #128
An oral surgeon Zambero Sunday #115
It's a problem. . . . h2ebits Sunday #131
99.9% of doctors accept Medicare dalton99a Saturday #58
it's the other way around Skittles Sunday #103
When I researched it, snot Saturday #34
Over half of Medicare eligible beneficiaries choose MA plans, primarily because of cost. I do agree a Public Option Silent Type Saturday #38
The Advantage cos. do all they can to make their plans appear attractive, snot Saturday #41
So you think 31 million people are stupid? Maybe if original Medicare met their needs, Silent Type Saturday #48
Maybe not stupid but ignorant. Brenda Sunday #109
Actually, it might be an opportunity if your MA plan is eliminated. Then, you have a guaranteed right to return to Silent Type Sunday #132
"Choose another MA plan" Brenda Wednesday #156
Plenty of people do fine on MA, as DUers have posted, even though cancer, heart disease, Silent Type Wednesday #157
Insurance companies Henry203 Saturday #50
Whoever convinced you of all this was lying. OilemFirchen Saturday #57
The first warning about Medicare Advantage misanthrope Sunday #100
I think anyone campaigning on eliminating people's MA plans would face a lot of resistance MichMan Saturday #45
Totally agree. Maybe someone in Congress will realize that if they put those benefits in original Medicare and Silent Type Saturday #52
People are brainwashed Henry203 Sunday #117
That's essentially what Gallup called it. But thanks for responding. Silent Type Sunday #133
You loved Kaiser? Henry203 Wednesday #146
Glad your wife has survived. As others here on DU and elsewhere have posted, there ain't much evidence of Silent Type Wednesday #147
so Henry203 Wednesday #149
Hospitals and doctors bill those huge amounts to insurance, even Medicare, knowing that they will have Silent Type Wednesday #150
So it is OK Henry203 Wednesday #151
If you want quality care from Kaiser, it is. No one makes you sign up. Did your friend Silent Type Wednesday #158
i was with Blue Cross when this happened Henry203 Wednesday #159
Got it. In 2013 we didn't have pre-existing condition protection. Sorry about you daughter though. Silent Type Wednesday #160
Eleven years Henry203 Wednesday #161
Eat the rich and their enablers... problem solved NotHardly Saturday #39
My Medicare Advantage is just fine, thank you. I will be damned if I am going to pay 100, 200 a month more valleyrogue Saturday #40
You better Henry203 Saturday #51
Can I ask what your maximum annual out of pocket expense is? Sucha NastyWoman Saturday #70
Around $400. Henry203 Sunday #112
Is that the amount you have ACTUALLY paid in a year or the amount you could POTENTIALLY pay Sucha NastyWoman Sunday #119
My wife has cancer Henry203 Sunday #121
I thought Medicare Advantage only covered 80% of chemo treatments. Sucha NastyWoman Sunday #122
I have Medicare with a supplement Henry203 Sunday #123
the entire point of MA is to eventually GET RID OF MEDICARE Skittles Sunday #86
You better not get cancer Henry203 Sunday #118
Plus Advantage is costing the government more than traditional Medicare surfered Saturday #43
Good argument for Original Medicare w/o Supplement OKnow Saturday #44
I haven't read the link yet, but I have only regular Medicare and had surgery that required follow-up PE and Vinca Saturday #53
I think that dr. is nuts bagimin Saturday #80
Totally fed up with the so called "Advantage" Plan ReRe Saturday #49
No way am I again having an HMO determine my care. LiberalBrooke Saturday #55
The fact that they push this "advantage" so hard indicates how profitable it must be for them. patphil Saturday #59
Spot on Picaro Saturday #61
If you have original Medicare plus a supplement the insurance company that sold you the supplement MUST PAY their part Sucha NastyWoman Saturday #62
What percent of the eligible population does not have original Medicare, with or without a supplement? LAS14 Saturday #64
I am on an Advantage Plan. How can I get out and use traditional Medicare? Evolve Dammit Saturday #65
In most states you have to be approved to change to a supplement plan Sucha NastyWoman Saturday #73
Think I missed this years "enrollment period. December 7. Went with an advantage plan as it is free (no monthly premium) Evolve Dammit Sunday #125
You can easily choose original medicare at annual enrollment Desert grandma Sunday #97
Thanks for this! ShazzieB Saturday #66
My Friend F 72y/o Will Be Retiring Soon And Will Be Looking For A Medicare Plan..... global1 Saturday #68
About Medicare and pre-clearance Progressive dog Saturday #71
Medicare Advantage started in 1997 Progressive dog Saturday #72
Thank you for the correction - Ms. Toad Saturday #82
I have had a Kaiser Medicare Advantage plan for the past five years. Never denied anything. Sibelius Fan Saturday #76
The coming admin. SayItLoud Saturday #79
Look. Morbius Sunday #88
correct, their "healthcare plan" is to TURN IT ALL OVER TO PRIVATE INSURERS Skittles Sunday #101
Traditional Medicare doesn't include dental or vision coverage GoreWon2000 Sunday #84
that's how they entice people into the scams Skittles Sunday #87
Dental and Vision are cost prohibitive without insurance GoreWon2000 Sunday #89
there are some who don't fall for the scam Skittles Sunday #91
You didn't answer my question GoreWon2000 Sunday #92
I have extra insurance plans that cover them Skittles Sunday #93
You're paying more GoreWon2000 Sunday #94
like I said, THAT'S HOW THEY ENTICE PEOPLE Skittles Sunday #95
Traditional Medicare never addressed dental and vision coverage GoreWon2000 Sunday #96
Even though I pay more monthly for a supplement its more cost effective for me in the long run indigovalley Sunday #129
Your supplement is good for people in your situation GoreWon2000 Sunday #138
I pay for both Henry203 Sunday #120
I don't pay any extra premium for Medicare Asvantage GoreWon2000 Sunday #139
THANK YOU so much for this info. nt Raine Sunday #98
I knew a lady we rented a home from in 2005. She signed her mom up for that... C Moon Sunday #102
If it looks too good to be true...it probably is! PortTack Sunday #104
It seems like every other ad on TV is a Medicare Advantage ad. Jeebo Sunday #105
they drive me crazy (close to the title of a great 80s song btw) when I watch American streams Celerity Sunday #107
not specifically medicare, but.... thought of this markie Sunday #110
I have an appointment tomorrow wolfie001 Sunday #111
I didn't realize Medicare Advantage was a Bush thing MadameButterfly Sunday #114
Medicare C was signed into law by President Clinton in 1997 MichMan Sunday #135
I can't find those or the post that said it was signed into law by Bush MadameButterfly Sunday #141
Posts # 26 & #72 MichMan Sunday #142
I found it. post 85, the Tom Hartman report MadameButterfly Sunday #143
Correct, Clinton signed it into law; Bush just changed the name of it after it was already implemented MichMan Sunday #144
No thanks to either of them MadameButterfly Sunday #145
The commission an agent is paid by the insurance companies for selling a policy can be twice as much Sucha NastyWoman Sunday #127
People have a choice to get a MA plan or not MichMan Sunday #136
it should be criminal mike_c Sunday #137
I have a question - my friend tells me he signed up for a Medicare Advantage plan walkingman Sunday #140
🚩 thanks I need to start brushing up on this stuff underpants Wednesday #152
Medicare Advantage was always a solution looking for a problem. VMA131Marine Wednesday #153
This is a REALLY excellent thread! A KEEPER, most definitely. calimary Yesterday #162
Latest Discussions»General Discussion»The Medicare Advantage tr...»Reply #71