Medicare Will Require Prior Approval for Certain Procedures

[Zincwarrior]

Medicare is launching a pilot program using AI to determine whether patients are covered under some procedures in a manner similar to private insurers, that has been heavily criticized. Thoughts USMB?​

​

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

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. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients. Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence.

Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, said that the government would not review emergency services or hospital stays.

Mr. Sutton said the government experiment would examine practices that were particularly expensive or potentially harmful to patients. “This is what prior authorization should be,” he said.

​

The government may add or subtract to the list of treatments it has slated for review depending on what treatments it finds are being overused, he said.

But while experts agree that wasteful spending exists, they worry that the pilot program may pave the way for traditional Medicare to adopt some of the most unpopular practices of private insurers.

 

[debbiedowner]

Medicare is launching a pilot program using AI to determine whether patients are covered under some procedures in a manner similar to private insurers, that has been heavily criticized. Thoughts USMB?​

​

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

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. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients. Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence.

Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, said that the government would not review emergency services or hospital stays.

Mr. Sutton said the government experiment would examine practices that were particularly expensive or potentially harmful to patients. “This is what prior authorization should be,” he said.

​

The government may add or subtract to the list of treatments it has slated for review depending on what treatments it finds are being overused, he said.

But while experts agree that wasteful spending exists, they worry that the pilot program may pave the way for traditional Medicare to adopt some of the most unpopular practices of private insurers.

If it works to their liking they will roll it out nation wide. Pre auth everything is what the government wants. Health side of the business has been changing monthly since the new admin. Going to be a great 2026 for everyone, lol.

 

[1srelluc]

The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients.

Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence.

Well, look in the bright side, there a dozen procedures hospitals won't kill you over now.

I would have liked to have seen gender reassignments on that list.

 

[Harry Dresden]

Medicare is launching a pilot program using AI to determine whether patients are covered under some procedures in a manner similar to private insurers, that has been heavily criticized. Thoughts USMB?​

​

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

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. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients. Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence.

Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, said that the government would not review emergency services or hospital stays.

Mr. Sutton said the government experiment would examine practices that were particularly expensive or potentially harmful to patients. “This is what prior authorization should be,” he said.

​

The government may add or subtract to the list of treatments it has slated for review depending on what treatments it finds are being overused, he said.

But while experts agree that wasteful spending exists, they worry that the pilot program may pave the way for traditional Medicare to adopt some of the most unpopular practices of private insurers.

since when did medicare cover everything?...

 

[Mrkelly]

 

[initforme]

Another way to cut cut cut, until theres nothing left

 

[debbiedowner]

since when did medicare cover everything?...

They never have but they also have never required a pre authorization for an MRI or CT scan which this test in the 6 states will do.

 

[Winston]

The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients.

Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence.

Well, look in the bright side, there a dozen procedures hospitals won't kill you over now.

I would have liked to have seen gender reassignments on that list.

Yeah, Medicare pays for gender reassignment. LOL. Medicare doesn't even pay for hair transplants for those undergoing chemotherapy. Nothing cosmetic.

 

[Oddball]

Object lesson: Everything The State "gives" you can be taken away on a moment's notice, for any reason they can pull out of their ass.

 

[Zincwarrior]

They never have but they also have never required a pre authorization for an MRI or CT scan which this test in the 6 states will do.

Thats the difference being proposed.

 

[irosie91]

Thats the difference being proposed.

not really all that new-----just MORE SO. -----sad---waste of doc's time on telephone

 

[Rocko]

Medicare is launching a pilot program using AI to determine whether patients are covered under some procedures in a manner similar to private insurers, that has been heavily criticized. Thoughts USMB?​

​

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

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. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients. Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence.

Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, said that the government would not review emergency services or hospital stays.

Mr. Sutton said the government experiment would examine practices that were particularly expensive or potentially harmful to patients. “This is what prior authorization should be,” he said.

​

The government may add or subtract to the list of treatments it has slated for review depending on what treatments it finds are being overused, he said.

But while experts agree that wasteful spending exists, they worry that the pilot program may pave the way for traditional Medicare to adopt some of the most unpopular practices of private insurers.

Medicare has never approved every procedure.

 

[Zincwarrior]

not really all that new-----just MORE SO. -----sad---waste of doc's time on telephone

Unless the AI disapproves it of course.

 

[irosie91]

Medicare has never approved every procedure.

every procedure? no doubt it still does not-----I consider the idea entirely counter productive---
it requires too much MAN HOUR time----idiots deciding to what to object and doctors wasting
their time defending their orders----BIG WASTE

 

[Meathead]

Medicare is launching a pilot program using AI to determine whether patients are covered under some procedures in a manner similar to private insurers, that has been heavily criticized. Thoughts USMB?​

​

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

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. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients. Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence.

Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, said that the government would not review emergency services or hospital stays.

Mr. Sutton said the government experiment would examine practices that were particularly expensive or potentially harmful to patients. “This is what prior authorization should be,” he said.

​

The government may add or subtract to the list of treatments it has slated for review depending on what treatments it finds are being overused, he said.

But while experts agree that wasteful spending exists, they worry that the pilot program may pave the way for traditional Medicare to adopt some of the most unpopular practices of private insurers.

I don't get the problem. Seems eminently logical.

 

[irosie91]

I don't get the problem. Seems eminently logical.

it stinks like shit----people will die

 

[C_Clayton_Jones]

But while experts agree that wasteful spending exists, they worry that the pilot program may pave the way for traditional Medicare to adopt some of the most unpopular practices of private insurers.

They’re unpopular for good reason – denying perfectly appropriate, necessary procedures and treatments; the profit motivated private sector has long demonstrated it’s incapable of providing healthcare services.

 

[westwall]

Object lesson: Everything The State "gives" you can be taken away on a moment's notice, for any reason they can pull out of their ass.

A lesson leftists never seem to learn.

 

[Meathead]

it stinks like shit----people will die

This is an epiphany?

 

[irosie91]

This is an epiphany?

not at all it's nothing new