Medicare Advantage Plans Disadvantage Many Elderly and Disabled People

[Ms. Toad]

59. I'm hardly jumping to a conclusion.

In the specific incident being discussed authorization was required.

I have had several different insurance plans in my life. Some have required authorization for specialists, all required authorization for out-of-network to be covered at the same rate as in-network physicians, some have required authorization prior to going out-of-network (even if services were recovered at a reduced rate).

All plans I have had denied payment if prior authorization was required, but not obtained - and services which flowed from the unauthorized consult were also denied.

MA plans are modeled after standard insurance plans - that's the premise of MA plans.