We have experienced considerable delays and difficulties in providing patient care due to the prior authorization process required by BCBS Medicare Advantage. We have also experienced inappropriate denials of care which result in unacceptable delays as their appeals processes are long and complicated. This affects our ability to provide comprehensive and state of the art care to you, our patients.

Medicare Advantage plans (Medicare Part C) should not be confused with traditional Medicare (Parts A, B, and D). They are very different even though the funding for both are through the payments you have provided throughout the years to the Medicare Trust fund. Medicare Advantage plans are administered by private insurance programs for their profit whereas traditional Medicare is not. Medicare Advantage plans require prior authorization for several diagnostic services such as CT scans, MRI scans, sleep studies, PET scans, Holter/Event monitors, stress tests, and some laboratory tests. Many procedures such as pain injections, cardiac catheterizations and surgery also must be prior authorized before they can be scheduled. Copays are quite common for medications, tests/services of all types, consultations, and even some office visits. Traditional Medicare has none of those constraints and is accepted throughout the entire USA whereas Medicare Advantage plans are regional.

Please note, currently there are several facilities in Nebraska that are no longer accepting some or all Medicare Advantage plans. We have been notified all Avera facilities are no longer accepting Humana Medicare Advantage. Recently, the Nebraska Hospital Association issued a report detailing how Medicare Advantage is “failing patients and jeopardizing Nebraska hospitals.” The report cites negative patient experiences, placement delays, administrative issues, and financial burdens on hospitals which accept Medicare Advantage patients. Therefore, we advise all patients with any Medicare Advantage plan to carefully review their healthcare plan and ensure all the providers and facilities they use accept the plan they have chosen. We remind everyone that open enrollment will start on October 15 and runs through December 7. If you become dissatisfied with the plan you have chosen in the open enrollment period within the first 3 months, there are certain circumstances which allow you to change plans. Otherwise, you cannot change plans until the next open enrollment period. And, also realize that once you have left traditional Medicare, if you choose to return to traditional Medicare, your supplement insurance may have restrictions (if more than one year has passed) on pre-existing conditions.