Medicare Advantage plans denied prior authorization requests at unusually high rates, HHS report finds

[dalton99a]

https://www.nbcnews.com/health/health-news/medicare-advantage-plans-denied-prior-authorization-requests-unusually-rcna349467

Medicare Advantage plans denied prior authorization requests at unusually high rates, HHS report finds
UnitedHealthcare, CVS Health and Humana had the highest denial rates for long-term care requests, according to a report from the agency’s inspector general.
June 10, 2026, 11:01 PM CDT
By Berkeley Lovelace Jr.

Patients enrolled in some of the nation’s largest Medicare Advantage plans were denied requests for rehabilitation and other critical services at unusually high rates, according to a report released Thursday by the Department of Health and Human Services’ inspector general.

“These denial rates are quite staggering,” said Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh. “It’s another data point that reinforces what a lot of Americans have already been articulating a lot of frustration about — which is that healthcare decisions are being made with profit rather than medical necessity in mind.”

Erin Bliss, an assistant inspector general at HHS, said she was surprised by the findings.

“The range of denial rates from 8% all the way up to 80% by company for long-term care, that’s a pretty shocking variation,” she said.

...

https://oig.hhs.gov/documents/audit/11693/OEI-09-24-00330.pdf
June 2026 | OEI-09-24-00330
The Three Largest Medicare Advantage Organizations Denied Requests for Long-Term Acute Care and Inpatient Rehabilitation at Some of the Highest Rates

...

[bucolic_frolic]

1. But but but but Dr. Oz Medicare letter said only

patients and doctors made decisions. Yes he really wrote that recently.

[Midnight Writer]

2. I reckon AI will straighten this all out in short order.

We have some of our best minds working on it.

[CousinIT]

3. This is why "Dr Oz" wants to make Medicare DISAdvantage the DEFAULT for those who sign up

for Medicare.

UNLESS they specifically opt for standard Medicare and Medigap instead.

[RedWhiteBlueIsRacist]

4. One of my MAGA sibs just got cut-off with a so-called Medicare Advantage plan.

One is on food stamps too.

[H2O Man]

5. Recommended.

My advantage plan was cut at the end of 2025, because that plan became extinct and I had not responded to their letters to joing another plan. That struck me as odd ...... very odd, indeed, until my youngest daughter found that the letters to me had been mailed to my ex-wife's address, who lives a good 40 miles away and never let me know. Paying for my Rx's has been unpleasant in 2026.