wh 写了: 2024年 12月 13日 15:12
新闻怎么都说是uhc拒保?说ceo用错误百出的ai,使得拒保率猛涨?要是各大医保都用medicare电脑系统,那应该拒保率都差不多?
我可能错了
这是网上查的AI回复 uhc 是一家 medical advantage plan
Yes, a Medicare Advantage plan can decide whether a medical procedure will be covered by Medicare, as they have the ability to set their own coverage criteria for certain services, often requiring prior authorization for procedures that might be automatically covered under traditional Medicare; meaning the plan can review and approve or deny coverage based on medical necessity and their specific guidelines.
Key points about Medicare Advantage and coverage decisions:
Prior authorization:
Most Medicare Advantage plans require prior authorization for certain procedures, which means your doctor needs to get approval from the plan before performing the service.
Coverage criteria:
While they must follow general Medicare coverage rules, each Medicare Advantage plan can have its own standards for determining medical necessity.
Limited provider network:
Medicare Advantage plans often have a restricted network of providers, so you may need to use specific doctors within the plan to ensure coverage.