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Insurers Deny 1 in 8 Health Authorizations
15 Aug
Summary
- Insurers denied at least one in eight prior authorization requests last year.
- Denial rates varied significantly between different insurance companies.
- A majority of denied requests were overturned upon appeal.
Last year, health insurers participating in Medicare Advantage, Medicaid managed care, and Affordable Care Act (ACA) marketplace plans denied at least one in eight standard prior authorization requests. Analysis from KFF revealed denial rates fluctuating from 12 percent in Medicare Advantage to 18 percent in ACA marketplace plans.
Significant disparities were observed among individual insurers. For Medicare Advantage, denial rates ranged from 5 percent at Elevance to 17 percent at UnitedHealth Group. Medicaid managed care saw rates from 2 percent to 23 percent, while ACA marketplace plans experienced a range from 3 percent to 25 percent.
A striking finding indicated that a substantial portion of denied requests are later reversed. For Medicare Advantage, 67 percent of denials were overturned on appeal. Similarly, 47 percent of Medicaid managed care and 43 percent of ACA marketplace denials were reversed.
These statistics follow previous concerns raised by the U.S. Department of Health and Human Services regarding Medicare Advantage prior authorization practices. The Centers for Medicare & Medicaid Services (CMS) now requires plans to publicly report prior authorization data to enhance transparency.
