Medicare tests preapprovals

The practice of requiring providers to secure approval before performing a procedure is known as prior authorization. It is a tool for insurance companies to help control costs, but as one KFF Health News article points out, "Consumers and clinicians largely detest prior authorization." Perhaps unsurprisingly, in the current federal administration's effort to reduce costs, the practice of prior authorization is being tested out in traditional Medicare, which previously did not employ that practice. One point of irony is that this is happening as the federal government is currently trying to get commercial insurers to curb the practice.

This pilot seems to have been complicated by a rushed implementation and the seeming use of unreliable artificial intelligence. The article also points out that denials have been appealed, raising government costs. It is unfortunate that patients and providers bear the cost of a shaky rollout in terms of time and effort.