A recent Kaiser Family Foundation analysis found an increase in prior authorization requests from 2019 to 2022, along with a rising share of requests that were denied.
Summary
- Prior Authorization Request Increase: More than 46 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2022, up from 37 million in 2019.
- Increasing Denials: In 2022, insurers fully or partially denied 3.4 million (7.4 percent) prior authorization requests. The share of all prior authorization requests that were denied increased from 5.7 percent in 2019 to 7.4 percent in 2022.
- Few Denials Were Appealed: Just one in ten (9.9 percent) prior authorization requests that were denied were appealed in 2022.
- Majority of Appeals Overturned: 2 percent of denials that were appealed resulted in overturned denials.
Medicare Advantage Headlines >>
As his first cancer radiation treatment approached, his Medicare Advantage was canceled
For many patients who trusted their Medicare Advantage plans would be a helpful way to ensure care for the long
Three Health Insurers Exaggerated Medicare Advantage Enrollees’ Illnesses, Overcharging Taxpayers $140 Million
The disadvantages of Medicare Advantage programs can extend beyond frustration for patients and lower reimbursement rates for hospitals. A recent
Why Medicare Advantage Plans are Losing More Providers
Medicare Advantage plans’ excessive denials, restrictive provider networks, and contentious contract negotiations continue to increase the number of health systems
Medicare Advantage Has Become Notorious for Prior Authorization Burden
Medicare Advantage plans denied 7.4 percent of medical professionals’ prior authorization requests, or about 3.4 million requests, according to a
Ranking Medicare Advantage Insurers by Prior Authorization Denial Overturn Rates
While the majority of Medicare Advantage insurers overturn prior authorization denials when those decisions are appealed, the appeal process adds
See what else Groundswell Health is working on in healthcare >>
Support trending upward for rural healthcare
Strain and challenges for rural hospitals persist, but awareness is growing as lawmakers prioritize funding and programs for rural health
Groundswell Health Recognized With Industry Awards
Austin-based Groundswell Health this month received industry recognition for its work in strategic healthcare communications. The healthcare-focused communications firm
Celebrating Our Hospital Partners During National Hospital Week
May 12-18 is National Hospital Week, an opportunity to recognize and celebrate the hospitals, health systems, and dedicated health care
From Whim to WeWork to Winning Awards
Lance and I started working together in 2013. It didn’t take long to discover that what we had in common
