Medicare Advantage Denied 2 Million Prior Authorization Requests in 2021

Prior authorization is a practice used by health insurance companies to control costs by ensuring that procedures, treatments, and medications are medically necessary and prescribed for the right reasons. The process often requires the patient’s doctor to submit an authorization request beforehand, and the insurance company reviews it to decide whether or not to approve the procedure.

The KFF report found that the denial rate for prior authorization requests is much higher in MA plans than in traditional Medicare. The percentage of denied requests increased by 10% between 2020 and 2021. While the reasons for the increase are unclear, they may be related to new requirements that MA plans have implemented in response to the COVID-19 pandemic.

The report also found that certain specialties had higher denial rates than others, such as cardiology (17.5%), gastroenterology (13.2%), and radiation oncology (13.1%). This means that patients in these specialties may face even more difficulty in obtaining the treatments and medications prescribed by their doctors.

It is important to note that prior authorization is not only about controlling costs, but also ensuring that patients receive the treatments and medications that are most suitable for them. However, the high denial rate for prior authorization requests can add additional barriers for patients in need of medical care.

The KFF report highlights the need for MA plans to review their prior authorization requests and reduce the denial rate. Doing so would result in greater access to medically necessary treatments and medications for Medicare Advantage users.

Agility Producer Support
(866) 590-9771
[email protected]