By Blessing Nweke
A new report from the U.S. Department of Health and Human Services (HHS) Inspector General has revealed that some of the nation’s largest Medicare Advantage insurers denied requests for rehabilitation and other critical healthcare services at unusually high rates, raising fresh concerns about patient access to care.
The report, released Thursday, examined prior authorization requests made in June 2024 among 19 Medicare Advantage groups. It found significant differences in denial rates, particularly for costly services such as long-term acute care and inpatient rehabilitation, which are often required by patients recovering from strokes, heart conditions, severe fractures and other serious illnesses.
According to the findings, insurers including UnitedHealthcare, CVS Health and Humana recorded some of the highest denial rates, with certain requests rejected more than 70% of the time. Nearly 20 million Americans are enrolled in Medicare Advantage plans managed by those companies.
A separate HHS report focused on skilled nursing facility care found that insurers reversed 95% of denials when patients appealed. Officials said the unusually high overturn rate suggests problems in the initial review process.
“The range of denial rates from 8% all the way up to 80% by company for long-term care is a pretty shocking variation,” said Erin Bliss, assistant inspector general at HHS.
Health policy experts warned that denied requests can force patients to pay out of pocket or accept lower levels of care. They also noted that for-profit insurers appeared more likely than nonprofit plans to reject authorization requests.
HHS officials are urging the Centers for Medicare & Medicaid Services to collect more detailed prior authorization data and investigate why denial rates vary so widely among insurers. Industry representatives maintain that prior authorization helps control healthcare costs by preventing unnecessary treatments.
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