Healthcare DIVE August 14, 2024
More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.
Dive Brief:
- Medicare Advantage insurers fully or partially denied 7.4% of prior authorization requests in 2022, an increase compared to the previous three years, according to an analysis by health policy research firm KFF.
- Only 10% of patients appealed the denials in 2022, possibly because beneficiaries didn’t know about the appeals process or found it intimidating, according to the research.
- But when enrollees do appeal, more than 83% of the decisions were overturned — meaning needed care was likely delayed by the process.
Dive Insight:
Prior authorization, where providers are required to get insurer approval before offering a...
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