An online article posted on Axios Vitals highlights the problems patients and providers face with obtaining prior authorizations from Medicare Advantage plans. The article cites a KFF finding that there were 53 million prior authorization requests made to Medicare Advantage plans in 2024, of which 8% were fully or partially denied.
As stated by Representative Ali Bera, D-CA, who co-sponsored a bill that would require Medicare Advantage plans to reduce the time to respond to prior authorization requests:
What we’ve seen over the last two decades…is that a lot of the health plans have started to just routinely prior auth things that don’t need to be prior authed. It’s become more of a hassle factor, delay factor, often delaying care.
The article lamented that limits on prior authorization were not included in the recent governing funding deal.
Whatley Kallas, LLP’s provider clients have unfortunately experienced an increase in inappropriate denials and recoupments, as well as in denied prior authorization requests from Medicare Advantage plans. Providers, including Whatley Kallas’ clients, are becoming increasingly aggressive in challenging Medicare Advantage plans in arbitration.
The Axios Vitals article is linked here.