When you need medical care, time matters. But if you’re on a Medicare Advantage Plan, waiting could be part of the deal. In this post, we’re breaking down how Medicare Advantage (Part C) referrals and pre-authorizations can cause costly delays—and what that means for your health.
How Referrals and Pre-Authorizations Work
If you’re on a Medicare Advantage Plan, your doctor often can’t move forward with treatment until they receive approval from your insurance provider. This is known as pre-authorization, and it applies to many services, including:
- MRIs and CT scans
- Specialist visits
- Certain treatments or surgeries
Even if your doctor is in-network, they’re often required to submit paperwork and wait for approval, which can take days or even weeks. During that time, your condition may worsen, or you may be left anxious and unsure of what’s next.
The Referral Bottleneck
Once your doctor receives approval for diagnostic imaging, they might determine that you need to see a specialist. That’s when Medicare Advantage referrals and the delays kick in.
We’ve heard from clients who waited:
-
8 weeks for a referral
- We were only referred to a provider 60+ miles away
- Had to repeat the process just to see another doctor
This doesn’t just waste time—it can interfere with your health outcomes and quality of life.
The Risk of Waiting Too Long
Delays in diagnosis or treatment may lead to more serious complications, higher costs, and emotional stress. In emergencies or with progressive conditions, every day counts.
That’s why it’s so important to understand how your plan works before you need care.
What You Can Do
If you’re on a Medicare Advantage Plan and haven’t needed care yet, now is the time to take a closer look. Consider:
- Asking how long it typically takes to get referrals
- Reviewing your plan’s rules around pre-authorization
- Compared to a Medicare Supplement Plan, which doesn’t require referrals and allows direct access to any doctor who accepts Medicare
Final Thoughts
When it comes to your health, the ability to get fast, reliable care isn’t just a convenience—it’s essential. Don’t wait until a medical issue forces you to face delays. Know your options now.
📞 Questions? Our team at The Benefit Link is here to help. Contact us today by clicking “speak with an advocate” below for personal guidance.
