Pre-Authorization for All… and Medicare by Any Other Name

Remember Hyperbaric Prior Authorization which CMS had in effect for 3 states? They didn’t have to extend the program because it was so successful. Here’s a graph of the impact from 2014 to 2016 in which HBOT utilization decreased by 50%, and not just in those 3 states:

I was recently notified that effective January 1, Blue Cross Blue Shield (BCBS) has put both hyperbaric oxygen therapy (HBOT) and wound care services on its prior authorization list. In my area, that includes the Medicare Advantage plans.

I find the conversation about “Medicare for All” fascinating. The Medicare for All plan, as proposed, will outlaw private insurance companies (see my prior blog on the topic here). However, CMS is currently moving Medicare beneficiaries into Advantage plans run by those private payers as fast as possible. BCBS represents about 15% of the Advantage market.

So, although Medicare officially ended prior authorization, in fact, it’s still alive and well through the Medicare Advantage prior authorization programs which are rapidly taking over the market.  In other words, we now have a national hyperbaric prior authorization program, courtesy of the private payers and Medicare Advantage. At least, until it becomes illegal to have private insurance…