Quote:
Originally Posted by Marine1974
The volume of prior authorization determinations varied across Medicare Advantage insurers, ranging from 0.3 requests per Kaiser Permanente enrollee to 2.9 requests per Anthem enrollee.
Over 2 million prior authorization requests were fully or partially denied by Medicare Advantage insurers.
Just 11 percent of prior authorization denials were appealed.
The vast majority (82%) of appeals resulted in fully or partially overturning the initial prior authorization denial.
just curious why the 82 % reversal rate on denials was not included in the fact finding mission ?
The report I found that of the 2 million claims denied , could be more than one denial per person , does not come close to 11 million people getting a denial . There are approximately 35 million people currently on Medicare advantage plans . In order for your fact finding mission to be accurate, 1/3rd of all claims would have to be denied which is not the case .
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Out of curiosity, what does the patient with a medical issue do while all those appeals are being filed... twiddle their thumbs? No thank you!
We know some Medicare Advantage patients who have had what we consider less than ideal treatment for issues, including time in receiving treatment and providers. It's not what we expect when receiving medical care but finances put them in the Advantage situation.