Report: Medicare Advantage Plans Denied 2M Prior Authorization Requests

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The Facts

  • According to a report published by the non-profit Kaiser Family Foundation on Thursday, of the more than 35M prior authorization requests submitted to US Medicare Advantage Plans in 2021, 2M were either fully or partially denied by insurers.

  • Prior authorization requires providers to get approval before a service or other benefit is covered by a patient’s insurance in order to ensure the service is medically necessary.

The Spin

Narrative B

Prior authorization often denies vital services to vulnerable people, jeopardizing their health. Despite its deceptive name, Medicare Advantage is not the same thing as Medicare, as they leave patients without the benefits they need while overcharging the federal government for corporate profit.

Narrative A

Medicare Advantage gives people a choice in what insurance and benefits they want, and with that comes prior authorization — a necessary tool to control costs, make sure health care is necessary, effective, and efficient, and curb ever-prevalent medical fraud.

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