Medicare Will Require Prior Approval for Certain Procedures

Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare. This practice, known as prior authorization, has drawn public scrutiny, which intensified after the murder of a United Healthcare executive last December...

The Centers for Medicare and Medicaid Services plans to begin a pilot program that would involve a similar review process for traditional Medicare, the federal insurance program for people 65 and older as well as for many younger people with disabilities.

https://archive.ph/fC2wh#selection-685.0-689.178

 

One of the reasons that people choose traditional Medicare is to avoid the pre-approval process. Now seniors are getting screwed over. Should make a good issue for the Democrats in the midterms.

Huge numbers of illegal immigrants have been receiving Medicare, No surprise then, that regulations are tightening. 

7 minutes ago, cooked said:

Huge numbers of illegal immigrants have been receiving Medicare, No surprise then, that regulations are tightening. 

That's a lie.

6 minutes ago, Jingthing said:

That's a lie.

They dont get Medicare - but do qualify for Medicaid, no one gets turned away from health care.

8 minutes ago, cooked said:

Huge numbers of illegal immigrants have been receiving Medicare, No surprise then, that regulations are tightening. 

 

Nonsense. Back that  garbage allegation up with actual data.  Undocumented immigrants are largely ineligible for federal healthcare programs like Medicaid and Medicare and are ineligible for most federal health care benefits, aside from emergency care.  

 

The preapproval of procedures is specific to the procedures which have been subject to abuse and medicare fraud. The use of the model will not alter Medicare coverage or payment rules. While other services may be added later to the model, it explicitly "excludes inpatient-only services, emergency services, and services that would pose a substantial risk to patients if delayed". It is called responsible management of public funds.

 

People do not appreciate that without screening there is widescale fraud. Fraud  like this;

National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud

 https://www.justice.gov/usao-sdfl/pr/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146

1 minute ago, Explorator en Actione said:

They dont get Medicare - but do qualify for Medicaid, no one gets turned away from health care.

No, unauthorized migrants do not qualify for medicaid.

Just now, Patong2021 said:

No, unauthorized migrants do not qualify for medicare.

Read before you jump on something:  I said MEDICAID   -  it's a different program:  

What Is Medicaid?

Medicaid is a joint federal and state program that provides health coverage for people with low income, including many seniors. Eligibility and benefits vary by state, but generally include:

• Comprehensive coverage. Medicaid covers a wide range of services, including hospital and doctor visits, long-term care, and sometimes even additional benefits such as transportation and personal care services.
• Income-based eligibility. Unlike with Medicare, Medicaid eligibility is based on income and financial resources. Seniors with limited income and assets may qualify, and the program can assist with costs not covered by Medicare, such as long-term care.
• Dual eligibility. Some seniors qualify for both Medicare and Medicaid, and this is known as dual eligibility. For these individuals, Medicaid can help cover costs that Medicare doesn't, such as certain copayments, premiums, and long-term care. There may be other benefits as well.

21 minutes ago, Patong2021 said:

Nonsense. Back that  garbage allegation up with actual data.  Undocumented immigrants are largely ineligible for federal healthcare programs like Medicaid and Medicare and are ineligible for most federal health care benefits, aside from emergency care.  

 

So they show up in the ER for the sniffles, the hospital can't turn them away (by law), and then the hospital submits the bill to the taxpayers.

 

Illegal immigrants do not receive Medicare or Medicaid.  However, if an illegal immigrant shows up in an emergency room with a severe injury or an acute health crisis (like appendicitis), the hospital is obligated to treat him or her.  IF that person cannot pay the hospital bill, Medicaid will step in and reimburse the hospital.  

 

This does not apply to routine health care, only Emergency Room visits.  The alternative is to let the person bleed to death at the entrance of the hospital or to make the hospital absorb the costs of the treatment.  

 

This procedure follows laws passed under that 'woke, liberal' president Ronald Reagan...

In California illegals can  get Medi Cal. Yes it is a big budget item.  It got so big that even Gavin realized it cannot keep going as was in the past. Budget cuts are planned for Medi Cal in the 25-26 budjet. 

How many Americans today cannot afford healthcare? There must be a reason.

 

47 minutes ago, Patong2021 said:

 

Nonsense. Back that  garbage allegation up with actual data.  Undocumented immigrants are largely ineligible for federal healthcare programs like Medicaid and Medicare and are ineligible for most federal health care benefits, aside from emergency care.  

 

The preapproval of procedures is specific to the procedures which have been subject to abuse and medicare fraud. The use of the model will not alter Medicare coverage or payment rules. While other services may be added later to the model, it explicitly "excludes inpatient-only services, emergency services, and services that would pose a substantial risk to patients if delayed". It is called responsible management of public funds.

 

People do not appreciate that without screening there is widescale fraud. Fraud  like this;

National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud

 https://www.justice.gov/usao-sdfl/pr/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146

So, they go to emergency for everything. Been there and seen it in Calif.

Waiting for ER care is extremely inefficient medically and economically.

Yes people get acute emergency treatment there but that's the end of the care if not covered until the next ER emergency. Massively stupid system!

 

 

6 hours ago, impulse said:

 

So they show up in the ER for the sniffles, the hospital can't turn them away (by law), and then the hospital submits the bill to the taxpayers.

 

More nonsense. 

‘Crisis brewing’ in Trump Country as hospitals shutter at alarming rate, top ER doc warns

The study from the Arlington nonprofit research institute found that emergency rooms (ERs) are no longer the safety net but the proverbial "front door" to the U.S. healthcare system, particularly after a 1986 law passed requiring ERs to stabilize patients or deliver babies from women in labor regardless of their ability to pay.

That has led to instability and hospital closures across the heartland, including in states where a dozen or more have closed, like Texas, Oklahoma, and Tennessee. States like West Virginia, Pennsylvania, the Carolinas and Alabama have also been affected...

Nearly $5.9 billion in emergency services go unpaid every year, the study found. Overcrowding and spates of violence towards staff have exacerbated the problem.

https://www.foxnews.com/politics/crisis-brewing-trump-country-hospitals-shutter-alarming-rate-top-er-doc-warns

6 hours ago, EVENKEEL said:

So, they go to emergency for everything. Been there and seen it in Calif.

Medi-Cal. Not Medicaid.

7 hours ago, Explorator en Actione said:

They dont get Medicare - but do qualify for Medicaid, no one gets turned away from health care.

More nonsense. 

‘Crisis brewing’ in Trump Country as hospitals shutter at alarming rate, top ER doc warns

The study from the Arlington nonprofit research institute found that emergency rooms (ERs) are no longer the safety net but the proverbial "front door" to the U.S. healthcare system, particularly after a 1986 law passed requiring ERs to stabilize patients or deliver babies from women in labor regardless of their ability to pay.

That has led to instability and hospital closures across the heartland, including in states where a dozen or more have closed, like Texas, Oklahoma, and Tennessee. States like West Virginia, Pennsylvania, the Carolinas and Alabama have also been affected...

Nearly $5.9 billion in emergency services go unpaid every year, the study found. Overcrowding and spates of violence towards staff have exacerbated the problem.

https://www.foxnews.com/politics/crisis-brewing-trump-country-hospitals-shutter-alarming-rate-top-er-doc-warns

8 minutes ago, Alan Zweibel said:

More nonsense. 

‘Crisis brewing’ in Trump Country as hospitals shutter at alarming rate, top ER doc warns

The study from the Arlington nonprofit research institute found that emergency rooms (ERs) are no longer the safety net but the proverbial "front door" to the U.S. healthcare system, particularly after a 1986 law passed requiring ERs to stabilize patients or deliver babies from women in labor regardless of their ability to pay.

That has led to instability and hospital closures across the heartland, including in states where a dozen or more have closed, like Texas, Oklahoma, and Tennessee. States like West Virginia, Pennsylvania, the Carolinas and Alabama have also been affected...

Nearly $5.9 billion in emergency services go unpaid every year, the study found. Overcrowding and spates of violence towards staff have exacerbated the problem.

https://www.foxnews.com/politics/crisis-brewing-trump-country-hospitals-shutter-alarming-rate-top-er-doc-warns

 

15 minutes ago, Alan Zweibel said:

 

 

More nonsense. 

‘Crisis brewing’ in Trump Country as hospitals shutter at alarming rate, top ER doc warns

The study from the Arlington nonprofit research institute found that emergency rooms (ERs) are no longer the safety net but the proverbial "front door" to the U.S. healthcare system, particularly after a 1986 law passed requiring ERs to stabilize patients or deliver babies from women in labor regardless of their ability to pay.

That has led to instability and hospital closures across the heartland, including in states where a dozen or more have closed, like Texas, Oklahoma, and Tennessee. States like West Virginia, Pennsylvania, the Carolinas and Alabama have also been affected...

Nearly $5.9 billion in emergency services go unpaid every year, the study found. Overcrowding and spates of violence towards staff have exacerbated the problem.

https://www.foxnews.com/politics/crisis-brewing-trump-country-hospitals-shutter-alarming-rate-top-er-doc-warns

I just wanted to let you know that your post does not prove the OP is incorrect. 

50 minutes ago, Alan Zweibel said:

Medi-Cal. Not Medicaid.

Regardless what you call it. The entire emergency room, a very large area full of sniffles.

10 hours ago, EVENKEEL said:

So, they go to emergency for everything. Been there and seen it in Calif.

Yes, some go to the Emergency. It happens everywhere. Uninsured Americans do it everyday.  However, showing up at an ER does not  necessarily result in medical care. People can wait for long periods of time, or they can be denied care beyond stabilization.The federal government is not paying for the care. It is the state and county that pays, or if it is a non profit charity hospital, the designated charity fund.  You refer to California. That voters of that state have chosen to offer emergency care to everyone. It was their choice. 

11 hours ago, Explorator en Actione said:

Read before you jump on something:  I said MEDICAID   -  it's a different program:  

What Is Medicaid?

Medicaid is a joint federal and state program that provides health coverage for people with low income, including many seniors. Eligibility and benefits vary by state, but generally include:

• Comprehensive coverage. Medicaid covers a wide range of services, including hospital and doctor visits, long-term care, and sometimes even additional benefits such as transportation and personal care services.
• Income-based eligibility. Unlike with Medicare, Medicaid eligibility is based on income and financial resources. Seniors with limited income and assets may qualify, and the program can assist with costs not covered by Medicare, such as long-term care.
• Dual eligibility. Some seniors qualify for both Medicare and Medicaid, and this is known as dual eligibility. For these individuals, Medicaid can help cover costs that Medicare doesn't, such as certain copayments, premiums, and long-term care. There may be other benefits as well.

 

How much money is disbursed by the federal government on  Medicare and Medicaid for unauthorized   migrants?

Surely, if it is a crisis, you can offer the  amount that it is costing.

Thank you.