Report: Medicare Advantage Plans Denied 2M Prior Authorization Requests

Facts

• According to a report published by the non-profit Kaiser Family Foundation on Thursday, of the more than 35M prior authorization requests submitted to US Medicare Advantage Plans in 2021, 2M were either fully or partially denied by insurers.¹
• Prior authorization requires providers to get approval before a service or other benefit is covered by a patient’s insurance in order to ensure the service is medically necessary.¹
• Critics say that Medicare Advantage plans — reportedly made up of half the plans chosen by seniors — deny too many services that should be paid for under Medicare coverage rules. Traditional Medicare beneficiaries are rarely required to receive prior authorization.²
• Democratic representatives reintroduced legislation on Tuesday called the Save Medicare Act, which would formally change the name of the program to the Alternative Private Health Plan, in an attempt to clarify that the plans are run by private insurance companies.³
• This also come as Pres. Joe Biden proposed new regulations to bolster audits of the Medicare Advantage plans, which receive an annual per-person fee from the government.³

Sources: ¹KFF, ²Axios and ³Common Dreams.

Narratives

• Narrative B, as provided by Common Dreams. Prior authorization often denies vital services to vulnerable people, jeopardizing their health. Despite its deceptive name, Medicare Advantage is not the same thing as Medicare, as they leave patients without the benefits they need while overcharging the federal government for corporate profit.
• Narrative A, as provided by Omaha Insurance Solutions. Medicare Advantage gives people a choice in what insurance and benefits they want, and with that comes prior authorization — a necessary tool to control costs, make sure health care is necessary, effective, and efficient, and curb ever-prevalent medical fraud.