2024 Medicare Advantage Prior-Authorization Updates
New pre-authorization programs: United Healthcare Optum starts September 1, and Humana on August 29. We’ve shared resources for patient advocacy and will update you on any changes. Watch the video to learn more!
Referenced Links:
New Prior-Authorization Requirements For United Healthcare and Humana Medicare Advantage
Medicare Prior-Authorization Patient Flyer
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Transcript:
We want to give our members an update to a couple of things specific to the pre-authorization programs that are going to begin for specific Medicare Advantage plans. First, the United Healthcare Optum pre-authorization program will begin for chiropractic and physical medicine services on September 1. Additionally, Humana’s program for chiropractic services and pre-authorization begins August 29. We announced that last week, if you did not see the announcement that came out from both of those entities, we did put out an article detailing what we know at this stage regarding those pre-authorization programs. We’ll include that link down below, and you can take a look at that. Please be familiar with it.
One of the things that’s included in that article is a flyer that you’re able to give your patients that will enable them and empower them with information and allow them to advocate on their own behalf, to these entities, to these insurers, to protect their benefits and to ensure that they have free access and unencumbered access to chiropractic care and other physical therapy services. So it’s critical that you involve your patients in this process so that they can advocate for themselves. Additionally, we want you to know that probably the number one question that we’re getting at this stage is specific to, is this going to apply to out-of-network providers? What we’ve heard from a couple of different sources inside of UHC and Optum is the UHC Optum Medicare Advantage pre-authorization program that’s set to begin on September 1 actually will not apply to out-of-network providers.
However, we have not seen this specifically in official writing from United Healthcare or from Optum, but that is what we’re hearing. If we get more definitive information, of course, we will publish that and make that available as well. So watch that article as we will update it as we find out more information. However, in regards to Humana, we don’t know. There has been no release, nor have we received any information from inside of Humana as to whether or not that will specifically apply to out-of-network doctors. If we find out any further information on that, of course, we will let you know on that as well. But this is the information that we have at this stage, and hopefully at least gives you an update. We’ll let you know as things further progress on this issue. Thanks.
