New Medicare Program: Full List of Services That Will Need Prior Approval

[Ms. Toad]

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

interfering with the doctor-patient relationship.

Medicare Advantage is a standard insurance policy (whose coverage is dictated by the Medicare program). They are permitted to impose third party interventions in the relationship (limited network, prior authorization, etc.). Medicare is **generally** not.

There is a limited preauthorization requirement under Medicare - things which often double as cosmetic (eyelid lifts, for example) and DME (e.g. limits on coverage - like continuous glucose monitors which are covered only for certain T2 diabetics).

AI prior approval may be a growing trend in INSURANCE - but it is not a growing trend in healthcare. Medicare is a special program which does not require pre-authorization at all (let alone by AI) except in very limited circumstances when there is a specific, narrow, risk that the procedure is not covered under Medicare. That is different from a third party determining that the medical benefots of a covered procedure are not economically warranted.