Prior Authorizations, the necessary evil

Have you ever thought the concept of asking for forgiveness rather than permission would be a good idea when it came to your Medicare Insurance coverage? It is my hope that this article will help you avoid any nasty surprises in the future.

There might come a time when you need to have a medical procedure or treatment. You could be told you require medical equipment that may or may not have been discussed ahead of time. I want to be a voice of warning for some things that could happen when you get the equipment without discussing it with your insurance plan first.

I had a client call me recently. He had a procedure done and was told he would need a certain piece of medical equipment. The Medical Equipment Supplier didn’t bill insurance but told him he could submit the receipt for reimbursement.

If you have an HMO Medicare Advantage Plan, this will not work. In an HMO situation, you must use in network providers only. The only way another provider might be accepted is through prior authorization.

In the case of my client, this particular medical supplier was one of the only ones in the area who supplied the specific equipment that he needed. If there were no other suppliers available and his doctor would have requested prior authorization, that could have justified the Medicare Advantage HMO plan approving the equipment. But there is no guarantee, especially with a provider who will not bill insurance.

When it comes to insurance, it is always best to get prior authorization (ask for permission) rather than assume things will be covered after the fact (begging for forgiveness).

As always, I am happy to help answer your questions at anytime. Just give us a call or text.