Every chance I get, I try to inform people approaching Medicare eligibility age to avoid Medicare Advantage plans- prior authorization + networks is how insurance companies make money off what Medicare pays them. Deny or delay!
MA plans use prior authorization. In many cases, authorization is given only to have it changed sometimes before the surgery and even the day of the surgery. I have also known the auth to be changed after the surgery. What can be done about this??
If the insurance denies the claim due to lack of prior authorization, would the patient receive a bill for the allowed amount, or for the full price (chargemaster rate)? And also, would the patient's payment for the service count toward their out-of-pocket maximum, if insurance had denied the claim?
