CMS proposes certain payers implement electronic prior authorization systems by 2026

[Northeast Agent]

https://www.fiercehealthcare.com/pa...t-electronic-prior-authorization-systems-2026

The proposed rule comes as Congress could weigh in on the issue before the end of the year. The House overwhelmingly passed back in September the Improving Seniors' Timely Access to Care Act, which mandates electronic prior authorization for MA plans and requires quick approval times for routinely approved prior authorization requests.

The legislation has been in the Senate but has widespread bipartisan support.

 

[Yagents]

From what other agents say, pre auth has no effect on their mapd clients health. The delay allows more time for them to eat their broccoli.

What a waste of time and money? Or......maybe its about time the light is shined on mangled care

 

[DonP]

From what other agents say, pre auth has no effect on their mapd clients health. The delay allows more time for them to eat their broccoli.

What a waste of time and money? Or......maybe its about time the light is shined on mangled care

I bet I replaced 30 Med sups this aep . That’s $660 a pop . Boom !!!

 

[InsuranceGuy29]

From what other agents say, pre auth has no effect on their mapd clients health. The delay allows more time for them to eat their broccoli.

What a waste of time and money? Or......maybe its about time the light is shined on mangled care

In my opinion, respectfully, the only waste of money is guaranteeing an insurance company money when you don't have to. And I'll be ecstatic when this goes through. The supplement-only agents will finally have their mouths welded shut and they won't be able to drastically exaggerate the prior authorization issue, as they have been for years.

I actually made it a point to reach out to one of my clients, this afternoon, who is on a Humana (gaaaaaaaasp) HMO C-SNP that has a $2,500 MOOP and see how his chemo is going. I asked him if he had any delays at all in getting care, and his exact answer......

"Nope, not at all. Humana's care manager is constantly in contact with me, and so are the doctors at Loyola (which is a top-tier teaching hospital around here). They've all been great, and I can't thank you enough." ((End Call))

Maybe I should've tried to talk him into a supplement for $280/month, and a PDP for $40/month, and a dental/vision plan for $50/month. I'm sure burdening a guy with another $370/month (and counting) bill on top of his $170 Part B would've been a great idea.

My intelligence tells me getting him to spend another $4,810/year would've protected him so much better. I mean, could you imagine the HORROR if he ends up having to pay his $2,500 MOOP for the $150,000 of care he's receiving????

I hate to be snarky, but I'm so done hearing about the greatly exaggerated issue of "pRioR auThoriZatiOns!!!!!!"

P.S. Even though some of us disagree sometimes, I still love you SOB's! I know everyone means well and is just trying to do the job to the best of their abilities, and that they're just trying to do their clients some good. We just have different philosophies on things, and that's okay. And I'll even concede that in some of your regions, supplements might absolutely be the way to go if MA isn't that competitive. I totally understand that. But the blanket attacks on MA plans, as a whole, really need to stop.

 

[T Sparks]

In my opinion, respectfully, the only waste of money is guaranteeing an insurance company money when you don't have to. And I'll be ecstatic when this goes through. The supplement-only agents will finally have their mouths welded shut and they won't be able to drastically exaggerate the prior authorization issue, as they have been for years.

I actually made it a point to reach out to one of my clients, this afternoon, who is on a Humana (gaaaaaaaasp) HMO C-SNP that has a $2,500 MOOP and see how his chemo is going. I asked him if he had any delays at all in getting care, and his exact answer......

"Nope, not at all. Humana's care manager is constantly in contact with me, and so are the doctors at Loyola (which is a top-tier teaching hospital around here). They've all been great, and I can't thank you enough." ((End Call))

Maybe I should've tried to talk him into a supplement for $280/month, and a PDP for $40/month, and a dental/vision plan for $50/month. I'm sure burdening a guy with another $370/month (and counting) bill on top of his $170 Part B would've been a great idea.

My intelligence tells me getting him to spend another $4,810/year would've protected him so much better. I mean, could you imagine the HORROR if he ends up having to pay his $2,500 MOOP for the $150,000 of care he's receiving????

I hate to be snarky, but I'm so done hearing about the greatly exaggerated issue of "pRioR auThoriZatiOns!!!!!!"

P.S. Even though some of us disagree sometimes, I still love you SOB's! I know everyone means well and is just trying to do the job to the best of their abilities, and that they're just trying to do their clients some good. We just have different philosophies on things, and that's okay. And I'll even concede that in some of your regions, supplements might absolutely be the way to go if MA isn't that competitive. I totally understand that. But the blanket attacks on MA plans, as a whole, really need to stop.

Did you even bother to record this conversation?
JK

 

[Yagents]

We all have our own models and beliefs. Similar to politics.

Difference is, I don't have to call my clients to see if they had any issues with docs, hospitals, claims or pre auths.

DonP, and I lost only 1 to mapd, but moved a good 6 from mapd to supps. All running away from limited care. Yours ran away for financial reasons

 

[InsuranceGuy29]

Did you even bother to record this conversation?
JK

Not a chance. That's another thing the government can go pound where the sun doesn't shine.

 

[InsuranceGuy29]

We all have our own models and beliefs. Similar to politics.

Difference is, I don't have to call my clients to see if they had any issues with docs, hospitals, claims or pre auths.

DonP, and I lost only 1 to mapd, but moved a good 6 from mapd to supps. All running away from limited care. Yours ran away for financial reasons

I don't have to call them, either. I just did because the "mApD's aRe ThE deViL!" posts started making their usual biannual rounds on here and I just wanted to check in on my friend who has cancer and also has an MAPD. I always tell them if there's an issue to give me a ring. They know the drill. Still have a clean book of happy MAPD clients, and yes, even some supplement clients too. Different strokes for different folks.

 

[DonP]

I’m being super serious now . I bet I’ve moved 100 med sups to mapd last 2 yrs . Not once has one of the clients called me to say their unhappy . Not even one . You’d think one would have called

 

[T Sparks]

I’m being super serious now . I bet I’ve moved 100 med sups to mapd last 2 yrs . Not once has one of the clients called me to say their unhappy . Not even one . You’d think one would have called

Give it time...one will eventually, Just make sure you record it for us.