While the majority of Medicare Advantage insurers overturn prior authorization denials when those decisions are appealed, the appeal process adds additional delays to care that can harm both hospitals and patients. A recent Becker’s article ranked MA insurers by denial overturn rates and offered insight into which companies are the most and least likely to overturn a prior authorization decision when appealed.
From the article:
Medicare Advantage insurers denied 7.4% of prior authorization requests in 2022, up from 5.8% in 2021. Among those denials, 9.9% were appealed. Among those appeals, 83.2% of denials were overturned.
CVS Health denied the highest percentage of prior authorization requests in 2021 and 2022, denying 13% and 12% of prior authorization requests, respectively. Humana had the highest number of prior authorization requests per member in 2022, at 2.9.
Payers ranked by prior authorization request denial overturn rates in 2022:
- Centene: 95.3%
- Aetna: 90.8%
- Anthem BCBS: 89.2%
- UnitedHealthcare: 86.1%
- Cigna: 85.3%
- BCBS: 80.3%
- Anthem: 75.1%
- Kaiser: 69.5%
- Humana: 68.4%
See what else Groundswell Health is working on in healthcare >>
Content Marketing for Advocacy Influence
Politics is a science. You can demonstrate that you are right and that others are wrong. Jean Paul Sartre But,
How Will Your Hospital Communicate About Its “Shady Recycling Schemes?”
Yesterday’s announcement from CMS that it intends to subject hospitals’ Medicaid supplemental payments to increased scrutiny should raise alarm bells
More hospital CEOs putting attention on digital in communications and marketing
We see more senior leaders and CEOs taking a front seat when it comes to establishing a high-quality digital presence.
New Investment Will Continue Telemedicine Expansion
The slow but sure growth of telemedicine continues, and with today's announcement of a new round of funding for Texas-based