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 >>
Failure to Thrive: Why Big Tech Can’t Make it in Health Care
Last week, following the news that Google Health is disbanding, a Healthcare IT News article asked the question, “Is healthcare
Time to Confront the Limits of Health Care
This country doesn’t like conversations about death. We created the term ‘death panels’ to avoid a much-needed national conversation
Health care leaders stepping up, take stand on vaccinations with staff
More hospital system CEOs are taking steps to end a troubling trend in vaccination hesitancy among hospital staff. Most recently,
TCH21 – Increasing Efficiencies in Behavioral Health Through Tech
It's easy to say health care's efficiency woes should and could be improved by technology. It's another thing to
Medicare Advantage Headlines >>
Kaiser Family Foundation summary of Medicare Advantage trends and updates in 2024
The Kaiser Family Foundation summarized Medicare Advantage 2024 trends and updates in enrollment. Here are the main points: Enrollment
Humana tinkers with Medicare Advantage plans amid higher costs
As more seniors advance into Medicare eligibility, Humana noted decreases in its Medicare Advantage population leading to new consideration
