Medicare Will Require Prior Approval for Certain Procedures

[DrQ]

First there was IRMAA, now we will have WISeR (In 6 states for 17 procedures)

Medicare Will Require Prior Approval for Certain Procedures​

A pilot program in six states will use a tactic employed by private insurers that has been heavily criticized for delaying and denying medical care.

https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?unlocked_article_code=1.hk8.L_ZA.095JZYck6sPh&smid=url-share

 

[rapmarks]

Right now I have to wait 14 days for pre approval for an mri. Problem is I waited 80 days to see the dr, and she needs this to see if I need surgery. Twice I have sat in the Petscan room or the cat scan room waiting for them to approve the second part of the test, for instance head and neck. They approve head, but not neck, problem was cancer was in both places.

 

[DrQ]

Right now I have to wait 14 days for pre approval for an mri.

Yeah, in the linked YouTube video, he points out that MRIs currently require PA.

 

[Talent312]

I thought there weren't s'posed to be "death panels."
<rhetorical>
.

 

[rapmarks]

They won’t approve pet scans, and barely allow cat scans. My oncologist said if there is something suspicious on my cat scan, they will appeal for a pet scan

 

[Shiba]

Is the pre authorization issue with straight Medicare or Medicare Advantage?

 

[DrQ]

Is the pre authorization issue with straight Medicare or Medicare Advantage?

Watch the video and learn.

 

[Luanne]

Watch the video and learn.

Or just read the article. Looks like the pre-authorization that is now required for Medicare Advantage plans may now also affect traditional Medicare supplements.

 

[DrQ]

Or just read the article.

The video does a good job of explaining which state are affected and what procedures are subject to pre-authorization.

Looks like the pre-authorization that is now required for Medicare Advantage plans may now also affect traditional Medicare supplements.

That is not the case, just 17 procedures in 6 states. The program will expire in 6 years, so vote early and vote often. Elections matter.

 

[Luanne]

The video does a good job of explaining which state are affected and what procedures are subject to pre-authorization.

That is not the case, just 17 procedures in 6 states. The program will expire in 6 years, so vote early and vote often. Elections matter.

True, that is stated in the article. Sorry I wasn't more precise.