Latest News
Medicare Advantage and Prior Authorization - AJMC
For information, “Medicare Advantage” refers to private healthcare insurance which replaces the traditional government-run healthcare program known as “original Medicare.” Medicare Advantage plans have recently been in the spotlight for their seemingly strong tendency to manage their corporate expenses by denying insurance coverage by requiring pre-approval of certain medical procedures. A recent analysis by the American Journal of Managed Care (AJMC) found that the firms which offer Medicare Advantage plans tend to more frequently require pre-approval of medical treatment in more vulnerable socioeconomic areas. In other words, Medicare Advantage providers more frequently require pre-approval of medical procedures in U.S. counties which are predominantly poorer. This, of course, only adds to the frequent criticism of the Medicare Advantage program as a whole. Read about this situation in this article by two prominent PHDs writing for the American Journal of Managed Care.