Doctors Office Fights Medicare Advantage plan Denials of Prior Authorization

We said it a million times. A union who thinks they created a “custom” MA plan made especially for their members isn’t only lying to the people, they are lying to themselves. MA allows you to “customize” perks - like a debit card, silver sneakers, cab rides, etc, but these are at the DIRECT EXPENSE of access to ANY doctor or hospital in America that accepts Medicare - and that is about 99%. In NYC, Aetna’s sales rep told union leaders the only thing that was custom about their plan was it allowed Hospital for Special Surgery and Memorial Sloan Kettering in the network. While that is unusual as most specialty hospitals refuse to accept an MA plan, they did it as part of a business decision - most likely a temporary more favorable reimbursement. Kaiser Family Foundation and Department of Justice Found MA plans wrongly delay and deny prior authorizations - Aetna was about 13%. that is MILLIONS.. While the city finally agreed to temporarily “suspend” some, they never were honest about the number and they could be re-evaluated every two years by the city and our former unions. That is something we will never trust after what they did. In traditional Medicare, there are RARE prior authorization. If your doctor wants to treat you, they can! Listen to what this doctor’s office has to go through to fight for their patients. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit mariannepizzitola.substack.com