[BrianL99]

Originally Posted by rsmurano

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.


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.

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Close. Apparently Medicare requires pre-approval on about 1% of claims/procedures.

As has been pointed out 6 zillion times on this site and others, Medicare Advantage plans require pre-approval much more often. At least twice as often.