Medicare Advantage Plans Fielded 35 Million Prior Auth Requests in 2021

MedPage Today February 3, 2023
Sophie Putka

— Two million requests denied; reasons for denial remain elusive, according to a new report

Over 35 million prior authorization requests were submitted to Medicare Advantage insurers in 2021, according to a new report from the Kaiser Family Foundation (KFF).

Two million of these requests, or 6%, were fully or partly denied, according to Jeannie Fuglesten Biniek, PhD, associate director of the Program on Medicare Policy, and Nolan Sroczynski, MSPH, a data analyst for the Program on Medicare Policy, at KFF.

While only 11% of those denials were appealed, the vast majority (173,000 of 212,000) resulted in full or partial approval of the initial prior authorization request.

Prior authorization is meant to prevent patients from receiving medically unnecessary treatment, as...

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