It looks like the doctor has a good chance of winning the appeal. You just hope that the patient is alive at the end of the appeal process..
In 2022, MA plans denied 7.4% of prior authorization requests (3.4 million out of 46.2 million).
A 2019 study found 13% of prior authorization denials by 15 large MA plans were inappropriate and should have been covered under Medicare rules.
And 82% of appealed denials in 2021 were overturned.
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