New Yorker: A Man Was Murdered in Cold Blood and You're Laughing?

[Silent Type]

42. Here you go.

"Medicare Advantage insurers denied 3.4 million (7.4%) prior authorization requests in 2022. Of the 46.2 million prior authorization determinations in 2022, more than 90% (42.7 million) were fully favorable, meaning the requested item or service was approved in full.

Aug 8, 2024 Kaiser Foundation


From JAMA, published by AMA and essentially a physician union.

"Each year, millions of claims for medical services are denied by health insurance plans. Many denials may be justified as a necessary strategy to reduce wasteful spending from low-value care. However, denials may also delay diagnosis and/or treatment for patients, and appealing denials contributes to clinician workload and burnout.1 This tension is apparent in the Medicare program, where denials affect millions of beneficiaries who enroll in Medicare Advantage (MA). Although MA plans are required to cover the same services as traditional Medicare, these private plans are allowed to leverage utilization management tools, such as prior authorization, that traditional Medicare rarely uses.2 In 2021, MA plans denied approximately 6% of the 35 million prior authorization requests submitted. Although only 11% of these denials were appealed, the decisions were overturned in 82% of appealed cases.3 The regularity of reversals has raised questions about whether MA plans are deviating from their coverage obligations."
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815743