Congressional Democrats open investigation into Medicaid MCOs over claims denials

Healthcare DIVE September 29, 2023
Rebecca Pifer

Sen. Ron Wyden, D-Ore., and Rep. Frank Pallone, D-N.J., sent letters requesting information on coverage denials to insurers including Aetna and UnitedHealthcare.

Dive Brief:

• Top congressional Democrats have launched an investigation into the largest Medicaid managed care organizations in the U.S. over their prior authorization practices, after a watchdog report found high rates of coverage denials for beneficiaries in the plans.
• Senate Finance Committee Chair Ron Wyden, D-Ore., and House Energy and Commerce Committee Ranking Member Frank Pallone, D-N.J., sent letters on Thursday to CVS Health’s Aetna, Centene, Elevance, Molina, UnitedHealthcare, CareSource and AmeriHealth Caritas.
• The letters request information on the plans’ prior authorization processes, rates of appeals and whether they use algorithms in making coverage determinations.

Dive...

Today's Sponsors

Today's Sponsor