- Hi, I'm Sylvia Gordon.
- Hello, and I'm Rebecca Gordon.
- What are we talking about?
- We're gonna talk about prior authorization and this
bottleneck of people desperately needing procedures,
and they can't get authorized in time,
sometimes weeks or months.
And it's having a detrimental effect on their health.
Stay tuned.
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Multiple months.
So this is a really big deal.
So I know with Trump, they really tried to speed this up,
so that people didn't have to wait.
Now, we have our own personal experience
with people in our office,
in excruciating pain,
that kept getting denied, denied, denied
until they went through this step,
this step, this step, terrible,
and they still got the procedure,
and actually had a harder and a longer rehab.
So this is a big deal,
and this is a big problem in our industry.
- So I know you have a doctor's appointment, run out.
- Leave me, stranded.
- I will give you one more minute.
But all these things roll back to you.
The agent, you sold the policy, they're mad at you.
They put your reputation online.
- Why isn't that carrier doing it?
- Right. And they're like, I was there and I was happy.
Why did you move me here?
And now I can't get it.
This blows back on you be aware of it.
And it is something to warn your clients every year
to talk about it, of you having control over it.
And this, this is not just like one carrier's bad.
It used to be there is one carrier
that was especially bad years ago.
That carrier is not bad.
Now they're all kind of similar.
- Good luck.
- And I got, okay.
Just, just get out of here.
Okay. Now that she's gone,
I just want you guys to be aware of this.
It's something that should be part of your conversation.
Or like if you put it in a newsletter,
just something to get it out there to say,
Hey, I kind of warned you.
This is an industry wide problem that
the government knows about.
The Trump administration was urged to do something
and they go, okay, we're gonna do something.
Well then with the election,
this is kind of, been sidelined.
And so hospitals are urging Medicare
to do something about it.
And hopefully they do do something about it
because like they said, the data shows if you go,
which I could show you, but it's boring.
That it's been getting longer and longer.
And that people are dying.
There are negative outcomes because of this protracted delay
in getting prior authorizations.
And none of us want that.
It's hard not to get in with a new doctor.
And then it's hard enough if you have a doctor's,
just get an appointment.
We hear all this.
There is big shortage of general practitioners.
Nobody wants to be a GP anymore.
GP income is falling.
Everybody wants to go into specialist.
So we have all kinds of problems that are coalescing
into a perfect storm for us
because doctors get paid less on Medicare to begin with.
They get paid even less on Medicaid.
We're doing a lot with the snip market.
And it's just like,
they're mad at us for so many different things
that we have no control over.
So what you do have control over
is information, is education.
And like I said, educating your client
is the best thing you can do.
So they later, they're not coming back and saying,
why didn't you tell me this?
Why didn't anybody ever mentioned this?
I would have stayed on my Medicare supplement.
Now, if you're doing your work,
you're gonna tell them,
this is also happening on Medicare supplements.
It's not as bad,
but I've had many complaints on Medicare supplements too.
So prior authorization,
I know you guys don't wanna stay in a client's house,
in an apartment, or online appointment for three hours.
But it's just another thing,
if you can just kind of fit it in there,
and if you don't have time, put it in a newsletter,
because you want to be able to say,
yeah, we did talk about this.
This is like a problem with Medicare advantage,
and why you're healthy now.
And you think it might not be an issue,
two months later, a year later,
you need the knee or you need the hip,
and your doctor says, you need the knee.
And the insurance company says, you don't.
And then they're mad at you.
Because they're saying, why would the insurance company,
which you represent, contradict my doctor?
My doctor is the one that examined me.
And this was really frustrating
like Rebecca was alluding to,
for one of our senior VPs at Gordon Marketing,
because he'd already had one knee done.
The doctor said, you're gonna need
the other done in three years.
Three years he comes back,
he goes, yeah, we need it.
And Medicare said, no,
let's, let you wait.
So he was furious.
The funny thing is he was his own agent.
So he couldn't yell at anybody.
But sometimes all you can do is explain the rules.
And there's lots of minefields in Medicare.
If you're a new agent, you're like, ah
I'll just sell Medicare supplements.
No, Medicare supplements have their own minefields
such as the under observation,
preventing people from getting their skilled nursing.
I mean, there's just minefields everywhere
that blow up on you,
the representative of an insurance company.
So we can't, we can't prevent them,
but we can explain them upfront.
And we kind of distance ourselves from the problem.
You're doing the best you can,
but there are so many problems in our healthcare system,
and you're on the side of your client,
but you can't steer around all of them.
So happy AEP, join us next week.
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