Medicare advantage authorizations

[geauxg8rs]

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It never ceases to amaze how a patient with an insurance that requires a prior auth for an esi thinks that I am somehow to blame.

“I am hurting and want the injection now!”
“ your insurance requires an authorization. We will send the information right now. But they might take several days to get back to us.”

then they yell at me. Unbelievable.

 

[paindoc007]

It never ceases to amaze how a patient with an insurance that requires a prior auth for an esi thinks that I am somehow to blame.

“I am hurting and want the injection now!”
“ your insurance requires an authorization. We will send the information right now. But they might take several days to get back to us.”

then they yell at me. Unbelievable.

Yeaahhh. The best is “well now WHAT am I supposed to do in the mean time? Just suffer?”

 

[Laryngospasm]

My favorite is when the referring doc. Tells them they will get it at the first visit. So annoying.

 

[swamprat]

I tell them - well aren't you glad you got a free green humana mask?? Shoulda went with straight medicare we coulda done this yesterday

 

[jsaul]

Tell that patient he should have stayed with traditional medicare

 

[Laryngospasm]

I call them disadvantage plans

 

[mid|ine]

I let them know they can sign an ABN and pay OOP

 

[bedrock]

I let them know they can sign an ABN and pay OOP

Tell that patient he should have stayed with traditional medicare

I do both. I tell them that advantage plans are terrible and this is why they’re cheaper and they wouldn’t have had this problem with Medicare.

and for all insured patients, I tell them I can do the injection today if they want to pay cash now. If they want their insurance to pay , then they have to wait. That shuts them up right away.

 

[drrosenrosen]

I explain to people that Medicare is great for patients, not awesome for doctors. Most things are paid for, no auths or delays. They aren't paid much (hence not awesome for us), but they don't have to worry about whether most treatments will be covered. When they go in for an Advantage plan, they get the benefit of fewer out of pocket costs, dental coverage, etc, but they go back to the hassles of dealing with all the bs associated with insurance companies.

 

[mid|ine]

Medicare is better for docs and patients than Advantage though. No better pay for docs with "advantage" and all the headaches.

 

[Ferrismonk]

We also have been giving patients the complaint line email and phone numbers for our state's Department of Insurance and Finance Services. The only way the insurances will change is if there are enough patient complaints.

 

[Agast]

Tell that patient he should have stayed with traditional medicare

Apparently once you go Medicare Advantage it is very hard to switch back. You can get Medicare but may not qualify for a supplemental secondary. They can nail you on pre-existing conditions that occurred while you were on the advantage plan. My patient’s husband could not switch after he was diagnosed with spinal stenosis.

Use caution when ditching your Advantage Plan for original Medicare

If part of your intention is to get a Medigap policy when you make the switch, be aware that your coverage could be delayed or denied altogether if you have a pre-existing condition.

www.cnbc.com

 

[BobBarker]

You can always switch back to traditional Medicare or change advantage plans.

 

[NJPAIN]

Hum

 

[gaseous_clay]

What really bugs me is these plans deem procedures covered by traditional Medicare LCDs like SI joint LBBs/RFA and Vertiflex “experimental.”