Splitpair Not true at all, I can have any procedure I need and United will cover it.
Wow, no.
I hope that you won’t ever need to test that in real life.
If a Medicare Advantage plan, authorizations/precertifications are needed for anything bigtime.
It’s sometimes easier to date the Pope’s daughter, and the Pope does not HAVE a daughter.
If you mean traditional Medicare with a supplement, Medicare has an experiment underway to start requiring authorizations under that program AS WELL. It’s coming.
Even for LAB TESTS, Medicare will pay ONLY for those tests that match up with a specific diagnosis code.
FOR EXAMPLE, here are diagnosis codes for which Medicare (and many commercial insurers follow this too) will approve Thyroid blood tests.
https://www.questdiagnostics.com/content/dam/corporate/restricted/documents/mlcp/mlcp/national-guides/national-mlcp-190-22-thyroid_testing/National---MLCP---190-22---Thyroid-Testing.pdf (pdf)
Now, SOMETIMES we want to check Thyroid tests in someone with chronic hives—but that is NOT on the official diagnosis list—so Medicare would deny it.
If you’ve even been to a LAB while on Medicare, you have to sign an Advanced Beneficiary Notice (ABN) indicating that you’ve been INFORMED in advance that Medicare might deny payment.
Again, this gets more common with commercial insurers these days too.
For ALL fancy things, not just blood tests, but also CT/MRI, expensive medications, therapies and procedures.