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 >>
Beyond Brand: Patient Volume Marketing for Large Health Systems
For large health systems, in-house marketers often face pressure from multiple internal stakeholders to juggle a variety of creative projects
Speak to Your Community
Rural hospitals have a great opportunity to expand their online presence and reach virtually everyone in their communities with the
Boost the Right Patient Volume for Your Practice
Whether a practice is new or established, identifying new patient populations is key to any clinic’s success. We distill your
Vaccine Community Education and Engagement Grant
As vaccine rates drop across the state, Rural Health Clinics have a unique opportunity to upend entrenched health care
Medicare Advantage Headlines >>
Medicare Advantage Plans Announce Major Lobbying Blitz
As Medicare Advantage plans face myriad challenges, including rising costs, negative media coverage, and increased lawmaker scrutiny, the health insurance
Medicare Advantage Prior Authorization Requests Increase by Nine Million in Three Years
A recent Kaiser Family Foundation analysis found an increase in prior authorization requests from 2019 to 2022, along with a
