I wasn’t saying that MA would require pre-authorization for most things- just that it works like private insurance. When there is a question as to whether something is covered or not, the doctor or patient would go to the MA insurance for pre-auth. Typically (though not always), the MA plan also includes drug coverage as part of the same policy, so you don’t run into the Part B vs. Part D question that I think is at the heart of annamom’s problem with the injections.
It is true that the doctor/provider does have to request pre-auth for standard insurance – but it is more common that the patient will have to request this to get it done. Example: my doctor referred me for a bone scan at age 63. My insurance benefits statements says that is covered at age 65, and at age 60-64 under certain conditions. I called the insurer to ask whether it would be covered in my case, and they said preauthorization was necessary. They told me my doctor would need to request it, and explained exactly what to do. I then contacted my doctor to request that they get preauthorization. Nothing happened. My doctor later claimed that they had tried to get the authorization but never heard back from Blue Shield. I don’t believe her. In any case, I didn’t get the scan. I will get it after I turn 65, assuming Medicare will cover.
But the point is that with private insurance there is a system in place for “preauthorization” of some services which may or may not be covered depending on circumstances.
With standard Medicare + Medigap the process is different.