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Ms. Toad

(37,811 posts)
Tue Sep 30, 2025, 02:18 PM Sep 30

Yes and no.

Pre-approval is rare, but not new, for traditional Medicare. It is currently limited to around 50 outpatient procedures which are primarily cosmetic - but also occasionally medically necessary.

This new program adds 17 medical procedures, and farms pre-approval out to an AI company with a profit motive to deny procedures.

So the concept of pre-approval to weed out procedures which are not covered by Medicare (when used cosmetically) is not new - that armor cracked in 2020. Shifting to interfering with medical procedures which are covered, but which some morons decided were being abused, and farming out the pre-approval to a company with a profit motive is new.

I've written all my congress critters about my concerns, objecting to the new program - using my personal example (I had one of the procedures which is subject to pre-approval in the state in which I live, come January - AND - if the procedure had been denied it would have delayed surgery long enough for my cancer to metastasize, rather than being restrained to a local tumor . . . with the kicker that my insurance company denied payment for the procedure after the fact, so it is likely that had I been on Medicare with pre-approval required at the time some AI-bot would also likely have denied it. It was approved on appeal, but the time for the appeal was months.) I hope you will do the same - even if it isn't incredibly effective, communicating with congress-critters is more effective than posting on DU.

Latest Discussions»General Discussion»Yes and no.