Prior authorization is commonly used to slow the process of people getting the care they need. It is one of the commonly used methods to discourage people from getting the care they need and often just creates frustration for both providers of the care and their patients.

Interestingly, seniors who choose Medicare Advantage plans are often using more medical services as they age, and the plans that people use which are a replacement for medicare often use prior authorization to delay needed care and frustrate the elderly who are trying to follow their doctors recommendations.

While insurers argue that prior authorization is necessary to reduce waste, often it is just another delay tactic used to making getting the medically necessary care more difficult to obtain as a covered service. If someone forgets to get the prior authorization, the cost falls on the patient. Some doctors including our office have found that prior authorization even when approved does not guarantee the services is going to be paid in a timely manner either.

In theory, it reduces costs and waste. In practice, it is just another beurocratic way of increasing the work doctors need to do that has no medical benefit but may cause harm with the delays to care it often causes.

In the case of chiropractic, we are often doing a pre authorization for companies such as United Healthcare’s Optum unit which serves no actual medical benefit but if you do not do it, you are not paid.

Traditional Medicare, which we as providers always recommend patients choose as they become eligible rarely requires recertification. The cost is affordable and the plan has most seniors very satisfied. Medicare Advantage plans often have the same or worse road blocks found in the traditional healthcare plans most people dealt with and they often find the plans offer less choice, fewer doctors and may even have high out of state costs if you spend time out of your own state as many people do during the winter months.

Thinking of rejoining Medicare if you were talked into Medicare Advantage first? It will result in a higher premium than if you joined Medicare initially. Our recommendation is to avoid Medicare Advantage plans altogether and join Medicare instead. You can use this link to join Medicare.

Interested in the NY Times article regarding Medicare Advantage Plans? Read the article below

When ‘Prior Authorization’ Becomes a Medical Roadblock

Medicare Advantage plans say it reduces waste and inappropriate care. Critics say it often restricts coverage unnecessarily.

By Paula Span May 25, 2024

Slowly but steadily, Marlene Nathanson was recovering. She had suffered a stroke in November 2022 at her home in Minneapolis and spent a week in a hospital; afterward, when she arrived at Episcopal Homes in St. Paul for rehabilitation, she couldn’t walk. Weakness in her right arm and hand left her unable to feed herself, and her speech remained somewhat garbled.

But over three weeks of physical, occupational and speech therapy, “she was making good progress,” her husband, Iric Nathanson, said. “Her therapists were very encouraging.” Ms. Nathanson, then 85, had begun to get around using a walker. Her arm was growing stronger and her speech had nearly returned to normal.