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

[Ms. Toad]

44. Healthcare is distinct from how that care is paid for.

Insurance is a means to pay for healthcare; it is not healthcare.

Insurance schemes which insert bean counters (AI or not) in the decision-making element of the doctor-patient relationship, is growing. That's not health care - it is a limitation on access to healthcare (since most of us aren't made of money). Nor is it part of the Medicare model of care.

One of the key features of original Medicare is that if a procedure is covered by Medicare when used for medical purposes, the doctor is free to use their own assessment in determining whether to use it.

Under Medicare rules, there are very limited circumstances in which a doctor is required to submit a medical decision to a third party for review before carrying out the decision. Those are, almost exclusively, DME or procedures which serve dual purposes (cosmetic and medical). These are not.