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%
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