DENYING CARE

A study on prior authorization and payment request denials by the largest Medicare Advantage organziations found many would be covered under Medicare coverage rules.
Here are the estimated percentage of denials that met Medicare coverage rules by type of request and the estimated percentage that were reversed within three months of the denial, during the first week of June 2019
The chart below is interactive: click or touch to see more.

[Chart]

Notes

Study examined largest 15 Medicare Advantage organizations by enrollment during the first week of June 2019.

Source: HHS Office of Inspector General report, “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” April 2022

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