A recent investigation by the HHS Office of the Inspector General reveals concerning trends in Medicare Advantage (MA) care denials, particularly among major insurers like UnitedHealth, Humana, and CVS. The reports highlight high denial rates for post-acute care—over 70% for long-term care admissions and more than 50% for inpatient rehab at these companies—raising alarms about seniors potentially being denied necessary care. Although many denials are overturned upon appeal, the delay in access causes significant health risks and financial burdens. Insurers are pushing back against the findings, citing data issues and underscoring the importance of prior authorizations while facing increasing scrutiny from lawmakers on the practice. As enrollment in MA is projected to rise, the debate over access to care and insurance practices intensifies.
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Link to original article source: https://www.healthcaredive.com/news/medicare-advantage-prior-authorization-denials-hhs-oig-post-acute-care/822724/
