Latest Breaking News

pnwmom

(110,182 posts)

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

Fri Dec 26, 2025, 07:06 PM

10 hrs ago

"Historically, traditional Medicare did not require prior authorization, but the new pilot program from the Centers for Medicare & Medicaid Services is adding this requirement for 17 services."

Edit history

Please sign in to view edit histories.

Recommendations

1 members have recommended this reply (displayed in chronological order):

IthinkThereforeIAM

65 replies

= new reply since forum marked as read

Highlight:

New Medicare Program: Full List of Services That Will Need Prior Approval [View all] BumRushDaShow 14 hrs ago OP

They really went after nerves. Is salvation through pain part of the plan? bucolic_frolic 14 hrs ago #1

Steroid injections have kept me ok on my feet redstatebluegirl 14 hrs ago #3

Me too. mgardener 14 hrs ago #4

This message was self-deleted by its author Trueblue Texan 13 hrs ago #11

I just got a shot in my shoulder LittleGirl 13 hrs ago #12

That should still be okay. Igel 13 hrs ago #17

Right? LittleGirl 11 hrs ago #41

Exactly. SergeStorms 11 hrs ago #42

Had that one too Bayard 5 hrs ago #59

Same here Bayard 5 hrs ago #58

That's what made Mother Theresa druidity33 13 hrs ago #21

How about a pilot program Henry203 14 hrs ago #2

Medicare Advantage is already set up to be able to deny claims for things that Medicare would automatically cover. thesquanderer 14 hrs ago #8

Advantage plans are private insurance, and they should be banned from using " Medicare" in their name. OMGWTF 13 hrs ago #18

I agree. Unless maybe they more honestly called it something like "Medicare Alternative" or "Medicare Private Option." thesquanderer 13 hrs ago #25

Alternative Medical Services. cstanleytech 6 hrs ago #57

They are literally Medicare plans, Authorized under the Medicare Part C statutes Ms. Toad 12 hrs ago #31

The person you're replying to said Advantage plans should not have been allowed as Medicare plans. pnwmom 1 hr ago #63

Ban "Medicare" from their name ENTIRELY Seinan Sensei 12 hrs ago #34

huh? Skittles 9 hrs ago #54

I should have said upcoding Henry203 8 hrs ago #55

AI prior authorization approval is already a relatively common practice anciano 14 hrs ago #5

And it needs legislatively banned. benfranklin1776 12 hrs ago #27

Not just the Ai part of it, but the outside authorization mahina 12 hrs ago #32

Agreed! benfranklin1776 5 hrs ago #60

But one of the main reasons to choose standard Medicare over a Medicare Advantage plan is to minimize a third party Ms. Toad 12 hrs ago #38

"Healthcare" is an umbrella term that encompasses anciano 11 hrs ago #39

Healthcare is distinct from how that care is paid for. Ms. Toad 11 hrs ago #44

So? People pay MORE to join Traditional Medicare so that they can choose their own doctors pnwmom 10 hrs ago #48

No LtTx 9 hrs ago #53

Yes, they do, in order to get Parts A and B, which covers both hospitalization pnwmom 8 hrs ago #56

And yet the govt is clamping down on prior authorization in Advantage plans pnwmom 1 hr ago #64

Brought to you by the same people who believe in ivermectin for covid Raven123 14 hrs ago #6

i've had the cellular. tissue application for foot wounds that would not heal rampartd 14 hrs ago #7

neck surgeries, knee surgeries, incontinence control, pain relief -- how very cruel, how very predictable 0rganism 14 hrs ago #9

So delay and deny are what's in store for our Buddyzbuddy 13 hrs ago #10

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

Our doc told us pre-approval is needed for what was our usual blood test AverageOldGuy 13 hrs ago #14

If you are no standard medicare, your doctor is wrong. Ms. Toad 12 hrs ago #36

Under an Advantage plan with an HMO dickthegrouch 13 hrs ago #15

But this experiment is being done with Traditional Medicare patients, which doesn't require prior authorization. pnwmom 10 hrs ago #49

Companies running this make money with every denied claim groundloop 13 hrs ago #16

Death by spreadsheet OMGWTF 13 hrs ago #20

Private insurance companies don't run traditional Medicare. ShazzieB 13 hrs ago #22

AI "death panels"..... SergeStorms 11 hrs ago #43

The whole reason Iʻm paying extra for supplemental ins is to keep the imperfect gem, traditional medicare, where mahina 13 hrs ago #19

"Just reading our DUers here and the impacts this would make to their lives is powerful." BumRushDaShow 13 hrs ago #24

This part caught my eye. ShazzieB 13 hrs ago #23

Amen 💪🏼 benfranklin1776 12 hrs ago #28

Don't You Mean OhioTim 10 hrs ago #46

I know what you mean, but I prefer not to think in those terms. ShazzieB 4 hrs ago #61

Doesn't sound reasonable or even rational Joinfortmill 13 hrs ago #26

Does one need advanced approval to die? milestogo 12 hrs ago #29

That's next... 2naSalit 10 hrs ago #50

So they're creating those death panels that Sarah Palin warned us about WestMichRad 12 hrs ago #30

Trump Qualifies For One OhioTim 12 hrs ago #33

two actually - do his diapers require prior approval? RainCaster 3 hrs ago #62

Deep brain stimulation for the treatment of essential tremor progressoid 12 hrs ago #35

At best, it will delay treatment. Treatment delayed is treatment denied. SunSeeker 12 hrs ago #37

It is not just AI needs to be destroyed - but the insertion of third party judgment (of any kind) Ms. Toad 11 hrs ago #40

I expect this is being pilot-tested to eventually become a permanent change (with more procedures needing prepproval) BumRushDaShow 11 hrs ago #45

I agree. Ms. Toad 10 hrs ago #47

I know for those of us feds who planned to maintain their FEHB insurance plans when Medicare-eligible BumRushDaShow 9 hrs ago #51

When I had a cancer diagnosis, I was in surgery 2 days after getting the diagnosis, pnwmom 1 hr ago #65

The U.S. is the only modern nation without a universal tax supported health care system for all their citizens. It makes ShazamIam 9 hrs ago #52