Medicare Advantage plans denied a record number of requests for prior authorization in 2022, according to a KFF analysis of federal data published Thursday.
“Medicare Advantage plans denied 3.4 million prior authorization requests for healthcare services in whole or in part in 2022, or 7.4% of the 46.2 million requests submitted on behalf of enrollees that year,” according to the analysis.
The share of prior authorization requests denied by MA plans was 5.7% in 2019, 5.6% in 2020 and 5.8% in 2021, according to the data.
One reason for the increase in denials could be the increase in MA enrollment in recent years, the authors said. Between 2019 and 2022, they said, the number of enrollees in MA plans increased from 22 million to 28 million people.
“Some lawmakers and others have raised concerns that prior authorization requirements and processes, including the use of artificial intelligence to review requests, impose barriers and delays to receiving necessary care,” Jeannie Fuglesten Biniek, Nolan Sroczynski and Tricia Neuman wrote for KFF.
Just 9.9% of prior authorization requests that were denied were appealed in 2022. The authors opined that the low rate of appeals could stem from MA members not knowing that they can appeal a decision “or finding the appeal process intimidating.”
A final rule announced by the Centers for Medicare & Medicaid Services in April revised the appeals process for Medicare Advantage beneficiaries who have been denied coverage. The rule should be a significant help for both beneficiaries and long-term care providers, sector leaders said at the time.
