Medicare, Prior Authorization
Use of Prior Authorization Up in Medicare Advantage Plans, Senate Report Finds
Medicare Advantage plans have increased their use of prior authorization and appear to be targeting certain types of care -- such as expensive post-acute hospital care -- for coverage denials, according to a report issued Thursday by the Senate Permanent Subcommittee on Investigations.
Senate report alleges MA insurers abuse prior authorization
Humana, CVS Health and UnitedHealth Group say a Senate panel is mischaracterizing spikes in prior authorization requests and denials for post-acute care.
Your Medicare Advantage Plan Is Being Canceled. Why It’s Not the End of the World.
When a Medicare Advantage plan is eliminated, the members can return to traditional Medicare and buy a Medigap supplement policy without being penalized for preexisting conditions.
Senate report scrutinizes Medicare Advantage prior authorization denials for post-acute care services
A report released Oct. 17 by the Senate Homeland Security Committee’s investigative subcommittee scrutinizes some of the nation's largest Medicare Advantage insurers for their use of prior authorization and high rates of denials for certain types of care.
‘Absolutely outrageous’ CT senator blasts Medicare Advantage insurers for denying care
Conn., blasted Medicare Advantage providers at a press conference in Hartford on Thursday for denying coverage for certain services through prior authorizations.
Medicare Advantage plans 'intentionally using prior authorization to boost profits': Senate report
The largest Medicare Advantage insurers have prioritized profits over patient care by increasing the use of prior authorization in recent years to frequently deny post-acute care services to older adults, according to a report published Oct. 17 by the Senate Permanent Subcommittee on Investigations.
Senate report hits top 3 Medicare Advantage insurers over ‘refusal’ of skilled nursing, other coverage
A Senate report published Thursday blasts the nation’s three largest Medicare Advantage insurers for increasingly limiting access to post-acute care and forcing vulnerable patients into “impossible choices” to protect profits.
UnitedHealthcare rolls out new therapy restrictions for Medicare Advantage plans
As of Sept. 1, Medicare Advantage members who need PT, OT, or ST in a physician’s office will need approval from UnitedHealthcare.  This will create headaches not just for enrollees, but also the therapists filing more paperwork,
‘Buyer beware.’ Sen. Blumenthal warns seniors about Medicare Advantage plans
Advantage plans promise to cover more services than Medicare alone, but a new report says carriers are denying patients critical rehab care. Insurers call the claims “misleading.”
Skilled Nursing News2d
U.S. Senate Subcommittee Raises Alarm Over Medicare Advantage’s Denial of Post-Acute Care
Medicare Advantage’s prior authorization process has resulted in higher denial rates among three of the largest health ...
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Medicare Advantage insurers ramped up use of technology to deny claims, Senate investigation shows
The Senate report extensively cites STAT’s investigation of the use of algorithms and artificial intelligence within Medicare ...
Commonwealth Fund11d
More Medicare Advantage Beneficiaries Are Filing Appeals for Denied Services or Treatments
A senior woman with a walker opens mail in her mailroom. When Medicare Advantage beneficiaries are denied coverage for ...
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Prior Authorization in Oncology: Burdens and Barriers to Care
Research suggests that prior authorization has negative effects on patients with cancer and oncology providers.