Medicare Plans Compared Based on Denial Rates for Specialized Care
Summary
A government report shows that private Medicare Advantage plans deny requests for specialized care, like rehabilitation and long-term hospital stays, at very different rates. Many of these denials are later overturned when patients appeal, indicating some patients may be wrongly denied treatment at first.Key Facts
- Medicare Advantage plans, run by private companies, deny requests for certain types of care before approving them.
- CVS Health/Aetna denied about 80% of requests for long-term care hospital stays.
- Humana denied about 72% and UnitedHealthcare denied about 71% of similar requests.
- For inpatient rehabilitation, UnitedHealthcare denied 66%, Humana 54%, and CVS Health 51%.
- Skilled nursing facility care denials are lower (about 12%), but 95% of those denials are overturned on appeal.
- Appeals often reverse a large portion of denials, showing initial denials might be improper.
- These specialized care services are important after hospital stays for recovery from serious health problems.
- Differences in denial rates are linked to insurer policies and prior authorization rules.
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