I asked a Humana salesman after he told me all my surgeries would have cost me the same under their advantage plan vs my supplement plan, can your plan refuse medical help that my dr prescribes? He told me yes and every procedure goes thru an approval process before the subscriber can get help and he tried to justify this as a good thing. I asked him why is it a good thing when Medicare itself does not require justification?
This advantage plan approval process has been in Congress for years. Check this out:
The Improving Seniors’ Timely Access to Care Act 2024 would streamline and standardize how Medicare Advantage uses prior authorization.
Prior authorization fixes earn majority support in Congress | American Medical Association
How about all the hospitals refusing the advantage plan?
Hospitals are increasingly refusing Medicare Advantage plans due to concerns about low reimbursement rates, excessive prior authorization requirements, and high claim denial rates, which they say are impacting their financial stability and ability to provide care effectively; this means that patients with Medicare Advantage plans may not be able to access care at certain hospitals unless the situation is resolved.
Hospitals are dropping Medicare Advantage left and right - PNHP
When these plans have to make things right, they will have to raise their rates or the backing insurance company will start losing money, which won’t happen for long.