r/fuckinsurance • u/Northern_Blue_Jay • 3d ago

Medicare Will Require Prior Approval for Certain Procedures (archived link in Comments section)

https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html
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u/LordFionen 2d ago

Other than the AI coming into it, Medicare has always had prior authorization for procedures. Been through it, been denied and been approved.

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u/Northern_Blue_Jay 1d ago

I guess they're saying it's going to get a lot worse, though.

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u/LordFionen 1d ago

With AI involved undoubtably

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u/Northern_Blue_Jay 1d ago edited 1d ago

Yes, and in the hands of corporations, programmed to serve and protect those interests. Good-bye Medicare, even if they still call it "Medicare." Your doctor's word used to be good enough. What did they go to medical school for?

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u/LordFionen 1d ago

Well even with Medicare doctors do have to know which codes to present and what it will cover. Medicare doesn't cover anything the doctor might want to do. Routine physicals for example. Not covered.

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u/Northern_Blue_Jay 1d ago edited 1d ago

Well, it should cover routine physicals. And for everyone in the country, too. What a bunch of frauds and clowns MAHA are. Thinking they can "make America healthy again" without a robust national single payer health care system, and at least 60% of the country one emergency away from being homeless.

All you have to do is take RFK Jr's advice? And he's not even a licensed nurse. And why would anyone take seriously a person who's abolishing vaccines, one of the greatest developments in 20th C modern medicine, and a guy who goes swimming in sewage, leaves a dead bear in the middle of Central Park, creating a public health hazard to children playing there, and known to have sexually assaulted the babysitter of his own children and under the roof of their mother? (Who he probably drove to suicide.)

And why is Trump currently hiding out? Karma ITO healthcare finally catching up to him? He might be revealed as the fraud he is ITO being in such great physical condition? What's the matter there? His face is all swollen? Running a high fever? He's not actually a god but an ordinary human like anyone else? And while Vance pants in the wings, hm?

I don't care about any of these politicians from either party if they're not solidly and aggressively in support of passing a national single payer health care system. Not one of them who isn't, is a "patriot" in my opinion, or gives a damn about the American people and the well-being of the United States of America. America is otherwise just their bank to rob, and their sponge to squeeze, for all its worth for their greed and corruption.

I've just seen too much at the hands of these crooks, I've lived it and am still living it, myself, and I've just listened to too many heartbreaking stories from my fellow Americans.

Maybe we're eventually heading into a war between AIs? Just as an AI can be programmed for evil, an AI can be programmed to fight for a revolutionary good. Healthcare for all, free at point-of-service, IMV, would be a revolutionary good for the United States, and it would also protect the UHC systems in other countries that are currently at-risk because of the Great Evil that dominates in our land at present, and via these "health" insurance companies, and most of our politicians in Washington DC who serve them on their knees, along with their painted clowns on mass media.

So that's where I'm coming from. I believe we need a revolution in healthcare. One that would include outlawing and abolishing "health" insurance companies, which are basically organized crime, federal indictments and jailing of their CEOs, immediate and aggressive expansion of an IMPROVED Medicare for all (like the Canadian model) or simply nationalizing the bastards (such as the U.K. model), either one of which, I'm fine with.

If I were "Tsar" of some DOGE, you would see the real thing (vs Musk's bullshit) - and in healthcare. And this in, itself, would transform the U.S. economy. There are some other things people need, too, but this would go a majorly long way, and virtually overnight, and with many more good things to happen, over the long term, as a consequence.

What about you? Where are you coming from?

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u/LordFionen 1d ago

Oh yeah I don't disagree at all. I've been for it since I first came online and came across PNHP and that was circa 1995. That's how long we've been fighting for this and how long we've been being laughed at by the insurance and other lobbies. Medicare as it is now needs a lot of improvements but the sad thing is still that it is far and away better than any commercial product from an insurance company and even though I'm pointing out that there is already prior authorization within Medicare, I'm definitely not for this administration F--ing with it especially with AI which has already been a disaster in other contexts. Also I don't know if you know this but Medicare is managed by private companies in regions across the US so that a procedure in one place will have a different price than in another place. The same procedure tends to be more expensive in rural areas too which is crazy. I've had Medicare most of my adult life and I think over all it's been a decent benefit but there have been things I couldn't get or couldn't afford because of Medicare rules and so I recognize all the ways it needs improvements. But even as is, it could serve as a basic benefit to give to everyone and if they want more coverage there could be supplements like there is now, but of course those have problems too. I can't get one because they are allowed to charge a lot more if you have a disability so to get one would cost me nearly $1000 per month and I couldn't afford even half of that.