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ShazzieB

(22,197 posts)

74. Yes, I see that now.

Sat Dec 27, 2025, 04:16 PM

Saturday

I posted that comment before reading the w hole article. (Never a good idea, I know.) I didn't realize private companies were going to be involved, perhaps because I have absolutely no experience with AI and no knowledge of how this stuff works.

Even more disturbingly, the article says this:

The larger concern is that companies conducting the review process will be incentivized to deny coverage because they receive payments when they lower costs.

The idea that these companies are actually going to be rewarded for denying coverage is perhaps the most disturbing piece of this, imo. This amounts to privatizing parrt of traditional Medicare, which should never have been allowed to happen.

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thesquanderer

79 replies

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Highlight:

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