Posted on 02/03/2024 6:10:43 PM PST by ChicagoConservative27
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.
The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.
(Excerpt) Read more at amp.theguardian.com ...
This sounds like an HMO insurance plan where you have a gatekeeper to decide whether you are worthy of treatment.
Are we ready to admit that the federal government controls the means of production and communication and business? Newspapers, Social media, agriculture, insurance, medical, banking, technology, cars. No business operates without federal government approval. There is no private anything.
“The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests.”
“Who work with federal programs”.....this points to Medicare Advantage plans, which are subsidized by tax dollars. The companies who offer these plans are definitely out to round up naive customers with slick ads, and then make all the money they can off of them.
Declare yourself an illegal, and all will be taken care of.
I thought that Øbama”care” was going to fix that.
I’m concerned that Guv’mint czars will be worse.
(There is no private anything.)
Obama says: “My work here is done.”
(I thought that Øbama”care” was going to fix that)
The suckers bought it!!
The purpose of business is to make money...for CEOs, CFOs, and sometimes, for stockholders.
The insurance bu$ine$$ makes money by raking in premiums and delaying or denying claims.
Economics 101.
No kidding. The freebies given out to the illegal invaders are certainly more than the $750 given to the fire victims in Lahaina.
Having worked in healthcare finance for 34 years, I know of no insurance that does not have some mechanism of requiring approval of care through "precertification" or managing length of stay. Even traditional Medicare accomplishes this through fixed payment systems (DRGs) and coverage determinations on outpatient services (LCDs).
It is also a two sided coin. Insurance and Medicare need to limit costs to keep premiums and taxes down. Doctors and hospitals need to be efficient and effective in delivering care because they too have scarce resources.
Sadly the days of Marcus Welby are long gone.
Hate these Obama-Biden rats.
FINALLY!
One single sensible policy proposal by the (puppet) Jomentia Regime!
A prior authorization is clarifying with an insurance company if you are covered for medication or a procedure from the contract you signed and should already know. There are rules within the contracts that don’t cover certain things like unless otherwise identified a woman couldn’t get a bust enlargement but she could get reconstructive surgery after breast cancer and be covered. These are health maintenance organizations, not department stores.
wy69
Might the new rules substantially increase costs and even ruin the private insurance companies?
What I was seeing in the article was the “gatekeeper” that I do not have with a PPO policy. Many times do we make appointments with specialists without having to see our primary care physician for approval.
what Bullshit, most if not all HMO’s what with Electronic records have authorizations with in 1 day.
this is more trash from the FJB admin, place more bullshit rules on medicare.
again bullshit
there is a think called reserves that each health insurance plan must keep, the fed rules are 85% to care and 15% to admin costs. more bullshit from the FJB admin
thank you
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