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pnwmom

(110,184 posts)

56. Yes, they do, in order to get Parts A and B, which covers both hospitalization

Fri Dec 26, 2025, 08:33 PM

Friday

and doctors and lab costs. But they choose Traditional Medicare (with Parts A and B) despite the higher cost because they aren't limited as to doctors and haven't been required to get prior authorization.

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New Medicare Program: Full List of Services That Will Need Prior Approval [View all] BumRushDaShow Friday OP

They really went after nerves. Is salvation through pain part of the plan? bucolic_frolic Friday #1

Steroid injections have kept me ok on my feet redstatebluegirl Friday #3

Me too. mgardener Friday #4

This message was self-deleted by its author Trueblue Texan Friday #11

I just got a shot in my shoulder LittleGirl Friday #12

That should still be okay. Igel Friday #17

Right? LittleGirl Friday #41

Exactly. SergeStorms Friday #42

Had that one too Bayard Friday #59

I get steroid shots in my scaphoid joint for arthritis. The list specifies that steroid shots in joints are not included Martin68 Yesterday #70

Same here Bayard Friday #58

That's what made Mother Theresa druidity33 Friday #21

How about a pilot program Henry203 Friday #2

Medicare Advantage is already set up to be able to deny claims for things that Medicare would automatically cover. thesquanderer Friday #8

Advantage plans are private insurance, and they should be banned from using " Medicare" in their name. OMGWTF Friday #18

I agree. Unless maybe they more honestly called it something like "Medicare Alternative" or "Medicare Private Option." thesquanderer Friday #25

Alternative Medical Services. cstanleytech Friday #57

They are literally Medicare plans, Authorized under the Medicare Part C statutes Ms. Toad Friday #31

The person you're replying to said Advantage plans should not have been allowed as Medicare plans. pnwmom Yesterday #63

No. They said they should be banned from using "Medicare" in their names. Ms. Toad Yesterday #69

Ban "Medicare" from their name ENTIRELY Seinan Sensei Friday #34

Medicare Advantage plans are PPO/HMOs, just like regular private company insurance carriers. Medigap is fee-for-service. valleyrogue 22 hrs ago #75

Medicare Advantage can require pre-authorizations not required for Medicare/Medigap, thesquanderer 19 hrs ago #77

huh? Skittles Friday #54

I should have said upcoding Henry203 Friday #55

AI prior authorization approval is already a relatively common practice anciano Friday #5

And it needs legislatively banned. benfranklin1776 Friday #27

Not just the Ai part of it, but the outside authorization mahina Friday #32

Agreed! benfranklin1776 Friday #60

But one of the main reasons to choose standard Medicare over a Medicare Advantage plan is to minimize a third party Ms. Toad Friday #38

"Healthcare" is an umbrella term that encompasses anciano Friday #39

Healthcare is distinct from how that care is paid for. Ms. Toad Friday #44

So? People pay MORE to join Traditional Medicare so that they can choose their own doctors pnwmom Friday #48

No LtTx Friday #53

Yes, they do, in order to get Parts A and B, which covers both hospitalization pnwmom Friday #56

And yet the govt is clamping down on prior authorization in Advantage plans pnwmom Yesterday #64

Brought to you by the same people who believe in ivermectin for covid Raven123 Friday #6

i've had the cellular. tissue application for foot wounds that would not heal rampartd Friday #7

neck surgeries, knee surgeries, incontinence control, pain relief -- how very cruel, how very predictable 0rganism Friday #9

So delay and deny are what's in store for our Buddyzbuddy Friday #10

We have to move to Medicare for all and cover everything. ChicagoTeamster Friday #13

Our doc told us pre-approval is needed for what was our usual blood test AverageOldGuy Friday #14

If you are no standard medicare, your doctor is wrong. Ms. Toad Friday #36

Under an Advantage plan with an HMO dickthegrouch Friday #15

But this experiment is being done with Traditional Medicare patients, which doesn't require prior authorization. pnwmom Friday #49

Companies running this make money with every denied claim groundloop Friday #16

Death by spreadsheet OMGWTF Friday #20

Private insurance companies don't run traditional Medicare. ShazzieB Friday #22

AI "death panels"..... SergeStorms Friday #43

But private companies WILL provide the AI services performing prior authorizations for Traditional Medicare. pnwmom Yesterday #66

Yes, I see that now. ShazzieB 22 hrs ago #74

Yes! You found the key point. That, and the fact that some of the decision makers pnwmom 21 hrs ago #76

The whole reason Iʻm paying extra for supplemental ins is to keep the imperfect gem, traditional medicare, where mahina Friday #19

"Just reading our DUers here and the impacts this would make to their lives is powerful." BumRushDaShow Friday #24

This part caught my eye. ShazzieB Friday #23

Amen 💪🏼 benfranklin1776 Friday #28

Don't You Mean OhioTim Friday #46

I know what you mean, but I prefer not to think in those terms. ShazzieB Yesterday #61

Doesn't sound reasonable or even rational Joinfortmill Friday #26

Does one need advanced approval to die? milestogo Friday #29

That's next... 2naSalit Friday #50

So they're creating those death panels that Sarah Palin warned us about WestMichRad Friday #30

Trump Qualifies For One OhioTim Friday #33

two actually - do his diapers require prior approval? RainCaster Yesterday #62

Deep brain stimulation for the treatment of essential tremor progressoid Friday #35

It's fairly new TexasBushwhacker Yesterday #71

I'm lucky (???) in that I'm already bald. :) progressoid Yesterday #72

I actually looked into the focused ultrasound TexasBushwhacker 30 min ago #78

At best, it will delay treatment. Treatment delayed is treatment denied. SunSeeker Friday #37

It is not just AI needs to be destroyed - but the insertion of third party judgment (of any kind) Ms. Toad Friday #40

I expect this is being pilot-tested to eventually become a permanent change (with more procedures needing prepproval) BumRushDaShow Friday #45

I agree. Ms. Toad Friday #47

I know for those of us feds who planned to maintain their FEHB insurance plans when Medicare-eligible BumRushDaShow Friday #51

When I had a cancer diagnosis, I was in surgery 2 days after getting the diagnosis, pnwmom Yesterday #65

That's the general basis for my personal concern with the skin and tissue substitutes Ms. Toad Yesterday #68

The U.S. is the only modern nation without a universal tax supported health care system for all their citizens. It makes ShazamIam Friday #52

WHY?? travelingthrulife Yesterday #67

RFK, Jr. and Dr. Oz lonely bird Yesterday #73