Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington poised to take it in the shorts from Bobby 'n' Oz on Medicare

[Miles Archer]

Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington are the six states involved.

Dr. Oz's new plan to root out Medicare 'waste' is actually a recipe for disaster

https://www.msnbc.com/opinion/msnbc-opinion/medicare-pilot-program-ai-prior-authorization-rcna229434

Starting next year, through its implementation of the Wasteful and Inappropriate Service Reduction (WISeR) Model, the Centers for Medicare and Medicaid Services (CMS) will begin a pilot program that will import the prior authorization process to traditional Medicare plans in six states. The program will even employ artificial intelligence tools to decide whether those Medicare beneficiaries will receive the care physicians say they need.

Private insurers usually deploy prior authorization to limit low-value care and contain health care costs. Though the tactic was used sparingly in its early days, it is now applied to most higher-cost drugs and nearly all surgeries and procedures. While most prior authorizations are ultimately approved, they are a source of headaches and frustration among patients and physicians alike, sowing distrust in the health care system. Prior authorization creates delays and denials of health coverage — and the process of challenging denials is highly burdensome, especially for people who are already struggling with severe or even life-threatening health conditions.

Appealing a coverage denial demands a high degree of health insurance literacy and fortitude that most of us lack, especially in a health crisis. Coordinating between one’s physician and insurer, all while potentially going untreated, can lead patients such as Daniel to experience a sense of overwhelm and a loss of autonomy amid this navigation anxiety. It is little wonder why so few patients ultimately opt to appeal. In fact, among the 3.2 million denials of prior authorization rendered by Medicare Advantage plans in 2023, just 11.7% were appealed despite most appeals resulting in a reversal of the initial denial.

[littlemissmartypants]

1. They are fixing to make a slew of folks mad.

The WISeR Model does not impact people enrolled in Medicare Advantage.

https://www.cms.gov/newsroom/press-releases/cms-launches-new-model-target-wasteful-inappropriate-services-original-medicare

Of course it won't, the venture capitalist bosses have paid for that not to happen with a big bribe. No doubt.

[ananda]

2. And another slew dead.

Boy those officials are cruel.

[BurnDoubt]

3. Yeah, but you can probably get ammo right away there. Just guessing.

[Karasu]

4. Now that they are part of the West Coast Health Alliance, Washington should tell Oz and RFK Jr. to go fuck themselves.

[lonely bird]

5. WISeR?

No, stupider and more cruel.

[Celerity]

6. The AI says you die. Oz death panel via computer.

[Mossfern]

7. I'm wondering if it's time

to move to another state.


ETA: We need a "sigh" smilie.
(sigh)