I’m guessing this person has an advantage plan! Because, if you had straight Medicare and or with a supplement, you don’t need prior approval. This is for 99.999% of the time, but you could have an outlier.
Here is a stat that everybody should look at when getting an advantage plan:
Almost all Medicare Advantage enrollees — 99% according to KKF — must obtain prior authorization for some services.
Advantage plans make the insurance companies rich while their clients usually give up trying to get a procedure approved.
I had a long conversation with an advantage plan salesman and he told me that my hospital procedure would have been $0 cost to me using his advantage plan compared to having my supplement plan. But then I asked him can you not approve my procedure? He said of course they look at all procedures and can approve or disapprove a request. I told him Medicare doesn’t require an approval to get something done so why do you? He said they are trying to be fiscally responsible.
Why do you think more and more hospitals are not taking advantage plan? Why has congress been working on this criminal procedures from the insurance companies when Medicare doesn’t require approvals.
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