[Leaning Right]

> …Peyton’s treatment at the facility was ‘medically unnecessary.’ <

Who makes that determination? Something similar happened to a relative of mine, although the injury was not nearly as severe as this guy’s.

In my relative’s case, I was told that the insurance company has a staff of doctors. One of them is chosen at random, and that doctor reviews the patient’s records remotely. The doctor does not actually examine the patient.

So here’s what I’m thinking. A doctor who approved of more treatment than the norm would be quietly dropped from the program.

By the way, my relative’s claim was denied by the remote doctor.

By the way #2, When you hit 65, do your research before picking an Advantage” medical plan. They’re run not by the government, but by insurance companies.

[George from New England]

Medicare Advantage is private insurance BUT IT IS FUNDED by the government. They will do everything they possibly can to deny benefits.

Humana took one of my meds that was $90 copay for 90 days last year and this year is $700 for same 90 days. This is the Linzess that is advertised on TV at $30 copay for 90 day.
Medicare laws force us seniors to pay the exorbitant price. Thank you Congress idiots.

[packrat35]

When you hit 65, do your research before picking an Advantage” medical plan. They’re run not by the government, but by insurance companies.

I can tell you stories about this when dealing with my wife.

[Keyser Soze 84]

So far, Medicare Advantage plans of Blue Cross/Blue Shield has worked well for us. My wife got good cancer treatment & saw many doctors without much problem, & I got an MRI for my knee injury this year……arthritis, bursitis, tendinitides, cyst, torn meniscus, bruised femur bone, sprained ACL….plus routine bloodwork for a chronic vitamin D deficiency & inactive thyroid. Obamacare followed by Medicare-for-All will probably be affordable only by killing old white people. ..but healthcare is a huge issue. An acquaintance told me how lucky I am to get Medicare for under $300/ mo because he is 62 years old and has to pay $1:500/ month for health insurance ,with a $10,000 deductible. That is shameful, owing $28,000 out of pocket each year before insurance pays anything. What is the point?
I can see how Medicare for all might be a real temptation for a lot of people.

[jurroppi1]

actually, that is a determination that can be appealed, so this is not the end for this kid or Mom. They should have a provider appealing on their behalf and writing up a strong medically backed reason why the initial determination of medically unnecessary should be reversed or at least reconsidered by actually reviewing the facts.

[Neanderthal]

"By the way #2, When you hit 65, do your research before picking an Advantage” medical plan. They’re run not by the government, but by insurance companies."

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There's no reason ever to choose Medicare Advantage. You give up control of your care and it is a Hotel California. You can't change back later to the best supplement plans like F and G without passing strict underwriting.