WisconsinWildcard
The plural of anecdote is not data
Re: 2020 Democratic Challengers III: Weekend at Bernie's
From some standpoints medicare is far above easier to deal with than many (most) private insurances. For the most part, I am happier when my patients have medicare than private insurance.
Some trends I notice day to day are:
1. Medicare patients get approved for rehab/skilled nursing much quicker and do not need something called "precertification" which is a fancy term that private insurance uses to make people wait in the hospital 3-4 days extra, make the team jump through hoops, and increase the risk of the patient having a complication keeping them in the hospital/the patient saying **** it and just going home against the team's recommendation. With bundled payments, the insurance company pays our hospital the same amount regardless of how many days they stay.
2. Pre-authorization for medications happens far less with medicare than with prior insurance. That usually is 30 minutes-1 hour of me sitting on the phone, talking with someone without a medical education about a medication and patient they know nothing about. Medicare for the most part reimburses less but I can see more patients if it cuts out some of the crap.
What was interesting is last week I actually had to do a preauth for a medicaid patient because I wrote for the generic but medicaid only covered the brand name because they had a discount. It only took me 2 hours and 6 phone calls to get someone to tell me why they are denying the medication instead of a 2 second pharmacy phone call.
From some standpoints medicare is far above easier to deal with than many (most) private insurances. For the most part, I am happier when my patients have medicare than private insurance.
Some trends I notice day to day are:
1. Medicare patients get approved for rehab/skilled nursing much quicker and do not need something called "precertification" which is a fancy term that private insurance uses to make people wait in the hospital 3-4 days extra, make the team jump through hoops, and increase the risk of the patient having a complication keeping them in the hospital/the patient saying **** it and just going home against the team's recommendation. With bundled payments, the insurance company pays our hospital the same amount regardless of how many days they stay.
2. Pre-authorization for medications happens far less with medicare than with prior insurance. That usually is 30 minutes-1 hour of me sitting on the phone, talking with someone without a medical education about a medication and patient they know nothing about. Medicare for the most part reimburses less but I can see more patients if it cuts out some of the crap.
What was interesting is last week I actually had to do a preauth for a medicaid patient because I wrote for the generic but medicaid only covered the brand name because they had a discount. It only took me 2 hours and 6 phone calls to get someone to tell me why they are denying the medication instead of a 2 second pharmacy phone call.
