Just thought that I would stir the MAPD vs MS pot again: Start at 2:25

[axeman462]

Are you saying the person qspoken of in the videqo did not literally die? Failure to reveal all possibilities in order to make a sale is downright dishonest.

Stop with your strawman logic.

 

[AgentGeneral]

You use terms "in many cases" and "doesn't happen often" which is true. But if you or your loved one is the one that it "rarely" happens to, that is not much consolation.

My loved ones are on these MAPDs.

Dad passed while on one a few years ago. Covid. never had a problem. Mom in law too,

He had COPD, Emphysema, a heart attack, two knees replaced, a hip replaced. Tons of medical appts with half a dozen specialists a home based physical therapist come to his home, on and on

Mom in law had everything from heart attack to kidney failure to skilled nursing. Never a problem

Spouse ? So healthy, just went on a Part B giveback.

I could go on, bc here everyone is on MAPD. No one complains. Maybe it's geo here but no issues EVER on networks or PA.

Caveat yes I'm fairly new at Medicare. Stayed away from all the fear mongering for years, but been affiliated with a company that has over 10k enrollees into MAPD. Those same people Ive worked with for YEARS all used to cry do F or G only back in 2009. Ummm No one wanted to deal with certs, etc. fast forward, 10k plus enrollees

Very few issues and so far no one hollering to go back to Supp.

 

[AgentGeneral]

Oh I should edit that out from "everyone" here on MAPD,

Because, you know, semantics scratching is a fun game in here.

 

[AgentGeneral]

Oh I should edit that out from "everyone" here on MAPD,

Because, you know, semantics scratching is a fun game in here.

Oh yah and edit above "no one hollering...." well maybe there was a few btwn 40 agents IDK. I haven't heard about it.

 

[sshafran]

Sounds like you just dug these people's own grave. There's a good chance you'll be charged for murder soon

 

[InsuranceGuy29]

How bout a beer? I have a lady buying her Old Milwaukees best at a Dollar General with her healthy bennies card. I know she shouldn't be but she somehow is....must be keyed in inventory as groceries or who knows...

I see the auths happen just as fast with MAPD in many cases. 10 minutes the other day for a senior patient needing a pain blocker on a PPO at a pain and spine clinic. Office girl says, "oh I need to get an auth". Picks up phone or whatever she did for 10 minutes, comes back and says ok doc be with ya in a bit. Not exactly like that, but it took her 10 minutes. You know what I mean. in that case the auth should have done prior to the patients arrival but wasn't and it didn't take long to get it is the point. It's not the olden days.

That's just an example. BCBS PPO has many providers in their MAPD network. Humana PPO not far off. Aetna HMO POS not my fave, but no ones complaining. PPO might be better. IDK I dont do alot of Aetna, but do some. Don't like the portal. My mains are BCBS and Humana.

It all goes back to what's the market dictate. Many geo areas have plenty of options and not very limited networks. Hence why this debate imo is silly.

If the argument on control over health care is for choosing providers then that's null here. It doesn't happen often where a client can't go where they want here as long as docs in network AND that doc is accepting new patients. One of the main ones I do has close to a million providers and then some. No issues.

In regard to prior authorizations, one thing no one seems to mention is that starting on January 1st, 2024, all codes that are automatically covered by Medicare will now be instantly auto-approved by computer. This is new legislation. My clients have never had problems with PA's. In my opinion it's a very exaggerated "problem" and a scare tactic, but that's my own opinion. Whenever my clients need medical services, they get them, and I make sure to check up on them regularly. But yes, no human eyes will need to see any sort of even routine authorization for any medical care that is automatically covered by original Medicare, starting in a few months, which completely eliminates the chance for error -- which was ruled the reason for the vast majority of initial "denials" (which are then usually overturned by immediate appeal) by the House Committee.

 

[gregj]

[EXTERNAL LINK] - By denying claims, Medicare Advantage plans hurt rural hospitals, say CEOs

some denials do happen. the bigger systemic issue, by far, and probably ultimately harder to rein in, is the enrollee health status gaming

 

[straightnochaser]

In regard to prior authorizations, one thing no one seems to mention is that starting on January 1st, 2024, all codes that are automatically covered by Medicare will now be instantly auto-approved by computer. This is new legislation. My clients have never had problems with PA's. In my opinion it's a very exaggerated "problem" and a scare tactic, but that's my own opinion. Whenever my clients need medical services, they get them, and I make sure to check up on them regularly. But yes, no human eyes will need to see any sort of even routine authorization for any medical care that is automatically covered by original Medicare, starting in a few months, which completely eliminates the chance for error -- which was ruled the reason for the vast majority of initial "denials" (which are then usually overturned by immediate appeal) by the House Committee.

This is awesome info, do you have a link or something?

 

[Duaine]

In regard to prior authorizations, one thing no one seems to mention is that starting on January 1st, 2024, all codes that are automatically covered by Medicare will now be instantly auto-approved by computer. This is new legislation. My clients have never had problems with PA's. In my opinion it's a very exaggerated "problem" and a scare tactic, but that's my own opinion. Whenever my clients need medical services, they get them, and I make sure to check up on them regularly. But yes, no human eyes will need to see any sort of even routine authorization for any medical care that is automatically covered by original Medicare, starting in a few months, which completely eliminates the chance for error -- which was ruled the reason for the vast majority of initial "denials" (which are then usually overturned by immediate appeal) by the House Committee.

Is this what you're speaking of? Starts in 2025 for some Medicare beneficiaries:
https://www.beckerspayer.com/policy...content=newsletter&oly_enc_id=2826C6645090A2G
CMS is proposing new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services.

"The goal of the health equity analysis is to create additional transparency and identify disproportionate impacts of utilization management policies and procedures on enrollees who receive the Part D low-income subsidy, are dually eligible, or have a disability," the agency wrote Nov. 6.

The health equity changes would be effective in contract year 2025 and are part of a broader proposed rule from CMS. Comments on the proposal are due by Jan. 5, 2024.

Three key proposals:

1. Medicare Advantage payers would be required to add a health equity expert to their utilization management committee.

2. The utilization management committee would have to conduct an annual health equity analysis of the insurers' Medicare Advantage prior authorization policies and procedures. The analysis would examine the impact of prior authorization on enrollees with one or more of the following risk factors: eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having a disability — compared to enrollees without those risk factors.

3. Payers would be required to publish the results of the analysis on their website.

 

[InsuranceGuy29]

Is this what you're speaking of? Starts in 2025 for some Medicare beneficiaries:
https://www.beckerspayer.com/policy...content=newsletter&oly_enc_id=2826C6645090A2G
CMS is proposing new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services.

"The goal of the health equity analysis is to create additional transparency and identify disproportionate impacts of utilization management policies and procedures on enrollees who receive the Part D low-income subsidy, are dually eligible, or have a disability," the agency wrote Nov. 6.

The health equity changes would be effective in contract year 2025 and are part of a broader proposed rule from CMS. Comments on the proposal are due by Jan. 5, 2024.

Three key proposals:

1. Medicare Advantage payers would be required to add a health equity expert to their utilization management committee.

2. The utilization management committee would have to conduct an annual health equity analysis of the insurers' Medicare Advantage prior authorization policies and procedures. The analysis would examine the impact of prior authorization on enrollees with one or more of the following risk factors: eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having a disability — compared to enrollees without those risk factors.

3. Payers would be required to publish the results of the analysis on their website.

This is something additional. This wasn't the main thing I was referring to. I have to try and find it, but it's a 100% fact that it's happening. No speculation. It's effective for everyone on Medicare Advantage plans. It will eliminate any delays for all prior authorizations and eliminate any chance for human error, which is the main cause of initial denials, according to the House Committee.