Is prior approval in MAPD that says it's not a guarantee they will pay the norm?

[yorkriver1]

This is making my client nervous. Maybe that's standard language, also of course, checking with the carrier, but finding someone who can answer that accurately could take a while.
Surgery and a pretty serious situation.

 

[vic120]

I would and do tell them this is the language, I cannot reassure you differently, yes many times they do not ask but sometimes they do, There are no guarantees

If you are that concerned about it lets do a med supp thats what we pay for

this way they make the decision and if they are concerned enough they will buy a med supp if they want the lower cost and extras more they will buy MA

Either way you are taking yourself out of the responsibility, of having told someone they will not have to deal with something they might

 

[somarco]

https://kffhealthnews.org/news/prio...th-bills-after-insurers-dont-pay-as-promised/

 

[somarco]

https://www.startribune.com/crucial...ital-patient-advocacy-medical-debt/600315283/

 

[rmhaire]

Today on MSN. More Scare Tactics


[EXTERNAL LINK] - MSN

 

[BibH]

Today on MSN. More Scare Tactics


[EXTERNAL LINK] - MSN

This whole original Medicare vs mapd was never about what was a better plan . It was about can someone making minimal money afford a med sup and pdp . The avg pdp has 40-60% rate increases in 2024 i’m seeing . Many med sup premiums seeing 10-15% and some 25% increases . The truth is most people making $50 k or less a yr never pay any hospital bills anyway . Inflations hit everything hard . On a positive note I noticed some of my clients aca premiums with big subsidy’s dropped a little . But all those subsidies will be chopped hard when Trump gets re-elected

 

[yorkriver1]

I would and do tell them this is the language, I cannot reassure you differently, yes many times they do not ask but sometimes they do, There are no guarantees

If you are that concerned about it lets do a med supp thats what we pay for

this way they make the decision and if they are concerned enough they will buy a med supp if they want the lower cost and extras more they will buy MA

Either way you are taking yourself out of the responsibility, of having told someone they will not have to deal with something they might

MA is not my default recommendation. Only for those who insist, and for those who can't afford Medicare supplements.
I have about 8 clients on full Medicaid. This is one. The way this would probably go lf the insurance co does refuse to pay is the program hospitals notify the patients about with signs on the wall, etc, that financial assistance based on income is available. The limit for 100% relief of bills is income below 200% of federal poverty level. One reason I asked the client to talk to the MD's billing dept. The doctor is part of the hospital chain where the surgery will happen. And the hospital can challenge the insurance company.