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Henry203

(851 posts)

55. I should have said upcoding

Fri Dec 26, 2025, 08:29 PM

Dec 26

The biggest scandal is insurance companies upcoding the patient’s treatment and getting extra money from the government.

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love_katz Skittles

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New Medicare Program: Full List of Services That Will Need Prior Approval [View all] BumRushDaShow Dec 26 OP

They really went after nerves. Is salvation through pain part of the plan? bucolic_frolic Dec 26 #1

Steroid injections have kept me ok on my feet redstatebluegirl Dec 26 #3

Me too. mgardener Dec 26 #4

This message was self-deleted by its author Trueblue Texan Dec 26 #11

I just got a shot in my shoulder LittleGirl Dec 26 #12

That should still be okay. Igel Dec 26 #17

Right? LittleGirl Dec 26 #41

Exactly. SergeStorms Dec 26 #42

Had that one too Bayard Dec 26 #59

I get steroid shots in my scaphoid joint for arthritis. The list specifies that steroid shots in joints are not included Martin68 Saturday #70

Same here Bayard Dec 26 #58

That's what made Mother Theresa druidity33 Dec 26 #21

How about a pilot program Henry203 Dec 26 #2

Medicare Advantage is already set up to be able to deny claims for things that Medicare would automatically cover. thesquanderer Dec 26 #8

Advantage plans are private insurance, and they should be banned from using " Medicare" in their name. OMGWTF Dec 26 #18

I agree. Unless maybe they more honestly called it something like "Medicare Alternative" or "Medicare Private Option." thesquanderer Dec 26 #25

Alternative Medical Services. cstanleytech Dec 26 #57

They are literally Medicare plans, Authorized under the Medicare Part C statutes Ms. Toad Dec 26 #31

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

No. They said they should be banned from using "Medicare" in their names. Ms. Toad Saturday #69

Ban "Medicare" from their name ENTIRELY Seinan Sensei Dec 26 #34

Medicare Advantage plans are PPO/HMOs, just like regular private company insurance carriers. Medigap is fee-for-service. valleyrogue Saturday #75

Medicare Advantage can require pre-authorizations not required for Medicare/Medigap, thesquanderer Saturday #77

huh? Skittles Dec 26 #54

I should have said upcoding Henry203 Dec 26 #55

AI prior authorization approval is already a relatively common practice anciano Dec 26 #5

And it needs legislatively banned. benfranklin1776 Dec 26 #27

Not just the Ai part of it, but the outside authorization mahina Dec 26 #32

Agreed! benfranklin1776 Dec 26 #60

But one of the main reasons to choose standard Medicare over a Medicare Advantage plan is to minimize a third party Ms. Toad Dec 26 #38

"Healthcare" is an umbrella term that encompasses anciano Dec 26 #39

Healthcare is distinct from how that care is paid for. Ms. Toad Dec 26 #44

So? People pay MORE to join Traditional Medicare so that they can choose their own doctors pnwmom Dec 26 #48

No LtTx Dec 26 #53

Yes, they do, in order to get Parts A and B, which covers both hospitalization pnwmom Dec 26 #56

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

Brought to you by the same people who believe in ivermectin for covid Raven123 Dec 26 #6

i've had the cellular. tissue application for foot wounds that would not heal rampartd Dec 26 #7

neck surgeries, knee surgeries, incontinence control, pain relief -- how very cruel, how very predictable 0rganism Dec 26 #9

So delay and deny are what's in store for our Buddyzbuddy Dec 26 #10

We have to move to Medicare for all and cover everything. ChicagoTeamster Dec 26 #13

Our doc told us pre-approval is needed for what was our usual blood test AverageOldGuy Dec 26 #14

If you are no standard medicare, your doctor is wrong. Ms. Toad Dec 26 #36

Under an Advantage plan with an HMO dickthegrouch Dec 26 #15

But this experiment is being done with Traditional Medicare patients, which doesn't require prior authorization. pnwmom Dec 26 #49

Companies running this make money with every denied claim groundloop Dec 26 #16

Death by spreadsheet OMGWTF Dec 26 #20

Private insurance companies don't run traditional Medicare. ShazzieB Dec 26 #22

AI "death panels"..... SergeStorms Dec 26 #43

But private companies WILL provide the AI services performing prior authorizations for Traditional Medicare. pnwmom Saturday #66

Yes, I see that now. ShazzieB Saturday #74

Yes! You found the key point. That, and the fact that some of the decision makers pnwmom Saturday #76

The whole reason Iʻm paying extra for supplemental ins is to keep the imperfect gem, traditional medicare, where mahina Dec 26 #19

"Just reading our DUers here and the impacts this would make to their lives is powerful." BumRushDaShow Dec 26 #24

This part caught my eye. ShazzieB Dec 26 #23

Amen 💪🏼 benfranklin1776 Dec 26 #28

Don't You Mean OhioTim Dec 26 #46

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

Doesn't sound reasonable or even rational Joinfortmill Dec 26 #26

Does one need advanced approval to die? milestogo Dec 26 #29

That's next... 2naSalit Dec 26 #50

So they're creating those death panels that Sarah Palin warned us about WestMichRad Dec 26 #30

Trump Qualifies For One OhioTim Dec 26 #33

two actually - do his diapers require prior approval? RainCaster Saturday #62

Deep brain stimulation for the treatment of essential tremor progressoid Dec 26 #35

It's fairly new TexasBushwhacker Saturday #71

I'm lucky (???) in that I'm already bald. :) progressoid Saturday #72

I actually looked into the focused ultrasound TexasBushwhacker Sunday #78

I'm on the fence about it. progressoid Sunday #79

At best, it will delay treatment. Treatment delayed is treatment denied. SunSeeker Dec 26 #37

It is not just AI needs to be destroyed - but the insertion of third party judgment (of any kind) Ms. Toad Dec 26 #40

I expect this is being pilot-tested to eventually become a permanent change (with more procedures needing prepproval) BumRushDaShow Dec 26 #45

I agree. Ms. Toad Dec 26 #47

I know for those of us feds who planned to maintain their FEHB insurance plans when Medicare-eligible BumRushDaShow Dec 26 #51

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

That's the general basis for my personal concern with the skin and tissue substitutes Ms. Toad Saturday #68

The U.S. is the only modern nation without a universal tax supported health care system for all their citizens. It makes ShazamIam Dec 26 #52

WHY?? travelingthrulife Saturday #67

RFK, Jr. and Dr. Oz lonely bird Saturday #73