Over 2M prior authorization requests denied by Medicare Advantage yearly

Prior authorization can delay patient care and cause frustration for physicians, who have to spend hours filling out paperwork every week. 

According to the most recent data from the Kaiser Family Foundation, over 35 million prior authorization requests were submitted to Medicare Advantage plans in 2021. 

Of those requests, over 2 million were fully or partially denied by Medicare Advantage insurers. Only 11 percent of those denials were appealed. Eighty-two percent of appeals were successful. 

Prior authorization requests are more common among some Medicare Advantage insurers than others. In 2021, Anthem received the most requests at about 2.9 per patient. Kaiser Permanente had the least, with .3 per patient. 

CVS was responsible for the most prior authorization denials in 2021, denying 12 percent of claims. Anthem and Humana denied the fewest claims, with only 3 percent each. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast