Use of Prior Authorization Up in Medicare Advantage Plans, Senate Report Finds

MedPage Today October 17, 2024
Joyce Frieden

— Post-acute care services targeted for coverage denials

Medicare Advantage plans have increased their use of prior authorization and appear to be targeting certain types of care — such as expensive post-acute hospital care — for coverage denials, according to a report issued Thursday by the Senate Permanent Subcommittee on Investigations.

Insurers “are using prior authorization to protect billions in profits while forcing vulnerable patients into impossible choices,” the subcommittee’s report concluded.

“This is particularly troubling when recent analyses indicate that Medicare Advantage is more expensive than traditional Medicare,” the report continued. “There is a role for the free market to improve the delivery of healthcare to America’s seniors, but there is nothing inevitable about the harms done by the...

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