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Originally Posted by huge-pigeons
Supplement plans do not cover drugs. I have a plan g supplement plan. They probably gave you one of the new plan g policies that are a high deductible so it might sound up front you are getting a deal until you use it, then it isn’t. Similar to comparing an advantage plan to a normal deductible plan g. Up front, the advantage plan looks great, $0 cost, drugs, eyes, on and on. But what they don’t tell you is that 99% of the time a dr recommends a medical service like an mri/catscan, or hundreds of other procedures, the advantage plan denies the service. This is a fact. This is so bad that congress is getting involved to create new laws that will eliminate or at least curtail these denial moved from advantage plans. Medicare does not require any pre-authorization of any dr work so if you use Medicare with any supplement, you will never be denied of medical work.
This just happened to me, I called my drug supplement people and they told me if I would go with the advantage plan, I would save money each year over what I paid last year with my plan g. They are correct because I went on a multiple fact finding mission to see if this was true. I found that 11 million people were denied medical service from advantage plans, that’s 1 way to save money, deny the work and both parties save. Also, most of these 11 million people did not fight the denial so they either didn’t do the service or they paid for it out of pocket.
Before going with any advantage plan, do your homework about this, or wait until Congress fixes this, but while you are waiting go with a plan g supplement
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The volume of prior authorization determinations varied across Medicare Advantage insurers, ranging from 0.3 requests per Kaiser Permanente enrollee to 2.9 requests per Anthem enrollee.
Over 2 million prior authorization requests were fully or partially denied by Medicare Advantage insurers.
Just 11 percent of prior authorization denials were appealed.
The vast majority (82%) of appeals resulted in fully or partially overturning the initial prior authorization denial.
just curious why the 82 % reversal rate on denials was not included in the fact finding mission ?
The report I found that of the 2 million claims denied , could be more than one denial per person , does not come close to 11 million people getting a denial . There are approximately 35 million people currently on Medicare advantage plans . In order for your fact finding mission to be accurate, 1/3rd of all claims would have to be denied which is not the case .