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

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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.

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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

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