Healthcare Uncovered Episode 2: Sorry, Your Request Is Denied: Medicare Advantage and the Rise of Prior Authorizations

Dr. Eric Bricker
Dr. Eric Bricker
March 29, 2023

Doctors are having to do more and more prior authorizations every year. In fact, almost 80% of practices say prior authorization frequency is increasing. Why? The answer is NOT obvious. I’m lifting the curtain on what’s really going on in this week’s episode of Healthcare Uncovered.  

In the second episode of Healthcare Uncovered we break down why prior authorizations are growing and alternative sources of patient revenue that do not have prior authorization requirements.  

What is the main reason for Medicare Advantage?  

The main reason for the growth in prior authorization is Medicare Advantage. In Medicare Advantage, the insurance company has prior authorization requirements for imaging like MRIs, tests such as sleep studies, and procedures like knee replacements. Traditional Medicare does not.  

Doctors are just getting a trickle of the payments from Medicare Advantage. And Medicare Advantage is growing like weeds.  

  • In 2010 only 25% of seniors were on Medicare Advantage and 75% were on Traditional Medicare.  
  • Today 50% are on Medicare Advantage and 50% are on Traditional Medicare.  

Why is Medicare Advantage growing?  

In The government gives so much money to insurance companies for Medicare Advantage, that insurance companies can frequently offer Medicare Advantage plans to seniors with Zero Dollar premiums, zero dollar deductibles, and no co-insurance. Your prior authorizations are going up because Medicare Advantage is going up and it is only going to get worse. By 2025 Medicare Advantage is projected to be 70% of seniors.  

Doctors, there are alternatives, you just need to look. We break it down further in Episode 2 of Healthcare Uncovered.  

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