Authorization Requests
Recent articles I have been reading suggest Medicare Advantage provides healthcare at a lesser cost than Traditional Medicare. Or maybe it would be better to qualify this as individuals claim MA plans do so?
I do not know whether such takes into consideration the cost of a Supplemental Plan or not and also Part D (pharma). Does this also include the premiums paid to Medicare Advantage companies? What I have been reading does not specifically say it is cheaper and I have yet to find the exact wording confirming such IN PRINT.
Here is something interesting which does not confirm the above, It does bring up an issue which may not be taken into consideration when examining costs . . . authorization requests by doctors which they submit to Medicare Advantage companies.
The extra time physicians spend on prior authorization requests and appeals of denials of care contributes to stress and burnout while taking away from time with patients.
In 2021, U.S. physicians spent at least 11.1 million hours on prior authorization requests for Medicare Advantage alone. Furthermore, an American Medical Association physician survey indicated that 35% of physicians said that prior authorization criteria used by insurers rarely or never followed evidenced-based guidelines approved by medical specialty societies.
More later.
Do the cost savings include the denials of care?
Joel:
Denials to authorizations would take into consideration a denial of care for the one request of authorization which implies another request for authorization on something different. This would not include 100% denial. I guess one could go through many denials until they arrive at the one the insurance company would accept.
I suspect a denial would include a cost save as the purpose of it.
in some ways denial at the very least it delays paying a claim (temporary cost saving). and in some cases patients and providers are probably just giving up (long term cost saving) . but these are cost savings for the insurance companies, and more of a gaming (as noted by some companies just deny and deny again) but doesnt really mean a reduction in costs (cause there is a cost in delaying care, as an old add use to say, you pay me now or pay much more lated
Grisham’s “The Rainmaker”