contacting medicare for pre-authorization ?

[calmom]

but in order to avoid unexpected bill, it seems that a patient does need to get authorization for every procedure.

No, I don’t think so with standard Medicare. (NOT Medicare Advantage).

Here’s more info about the Advance Beneficiary Notice – https://www.medicareinteractive.org/get-answers/medicare-denials-and-appeals/original-medicare-appeals/advance-beneficiary-notice-abn —

The notice must list the reason why the provider believes Medicare will deny payment. For example, an ABN might say, “Medicare only pays for this test once every three years.” Providers are not required to give you an ABN for services or items that are never covered by Medicare, such as hearing aids. Note that your providers are not permitted to give an ABN all the time, or to have a blanket ABN policy.

@Knowsstuff

We make every Medicare patient basically sign one to avoid this happening.

That practice is exactly what doctors are not allowed to do (although it might be acceptable for a lab to do so) If the ABN isn’t legit (doesn’t state the reason why a specific procedure or treatment may not be covered) – then it doesn’t protect you. A doctor isn’t allowed to bill a patient simply because there was an ABN – if Medicare doesn’t pay, it will also make a determination of whether or not the patient is subject to billing.

More links:

Patient not responsible if the ABN “Is given by the provider (except a lab) to every patient with no specific reason as to why a claim may be denied”. https://www.medicareinteractive.org/get-answers/medicare-denials-and-appeals/original-medicare-appeals/advance-beneficiary-notice-abn

“ABNs are only appropriate if the services you are providing are either noncovered or non-medically necessary.” “Medicare strictly forbids you from issuing ABNs across the board (i.e., to all Medicare beneficiaries).” https://www.webpt.com/blog/post/why-issuing-blanket-abns-is-a-no-no

@lookingforward

G pays for what Medicare doesn’t.

I don’t know if you are confused or are just not wording things clearly – but a Medicare supplement will NOT pay for non-covered services. There is nothing for a G recipient to look at, because all G policies are the same. They pay for the patient responsibility portion of the bill that Medicare does cover – the equivalent of copays and deductibles. G pays for everything except the Part B deductible. The G carrier has no discretion in that.

A medicare supplement plan (medigap) is not like Medicare Advantage (MA). MA does work like regular health insurance, requiring pre-auths, etc. – but for those of us like Annamom who are on traditional medicare, the process is different.