HomeCare February 14, 2023
BIRMINGHAM, Alabama—Medicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about 6% of the 35 million requests submitted on behalf of enrollees that year, a new analysis from the Kaiser Family Foundation found.
Prior authorization is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a service or other benefit is covered. While prior authorization has long been used to contain spending and prevent people from receiving unnecessary or low-value services, there are some concerns that it may create barriers to receiving necessary care. (Traditional Medicare only requires prior authorization for some services, including certain durable medical equipment, prosthetics,...
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