On October 17, 2024, U.S. Senator Richard Blumenthal (D-CT), Chair of the U.S. Senate Permanent Subcommittee on Investigations, released a 54-page report regarding its ongoing investigation of Medicare Advantage plans’ Prior Authorization and on-going denials. The report highlights how three major insurers: UnitedHealthcare, Humana, and CVS “intentionally use prior authorization to boost profits by denying post-acute care.”
As Sen. Blumenthal stated,
“Insurance companies say that prior authorization is meant to prevent unnecessary medical services. But the Permanent Subcommittee on Investigations has obtained new data and internal documents from the largest Medicare Advantage insurers that discredit these contentions. In fact, despite alarm and criticism in recent years about abuses and excesses, insurers have continued to deny care to vulnerable seniors —simply to make more money. Our Subcommittee even found evidence of insurers expanding this practice in recent years.”
The Center for Medicare Advocacy is grateful to Senator Blumenthal and the Subcommittee for tackling this urgent problem head-on. The data in this Report mirrors the beneficiary experiences the Center hears about every day: Medicare Advantage prior authorization and on-going Medicare denials create barriers to necessary care. In fact, these undue denials are growing as major insurance companies increasingly rely on AI, not health care experts, to make coverage decisions.
For beneficiaries and advocates, the message remains consistent: appeal, appeal, appeal! Medicare Advantage plans issue prior authorization and on-going denials with little human oversight and bet on beneficiaries not appealing. More information about how to handle Skilled Nursing Facility and Hospital Discharge Appeals can be found on the CMA website.
October 24, 2024 – C. Huberty