Advantage Plans Deny 6% of Treatments

Here’s something you should know about Medicare Advantage plans: the vast majority of these insurance policies require prior approval before a person can receive some medical treatments and services. Historically, that was not the case, and prior authorizations are still very unusual for people who are enrolled in original Medicare and a Medigap supplement. But in the case of Medicare Advantage plans, physicians submitted more than 35 million requests for prior authorization to insurers in 2021, and more than 2 million of them – or about 6 percent – were fully or partially denied, according to the Kaiser Family Foundation’s new report on more than 500 Advantage plans. Only about 11 percent of the denials were appealed, but the vast majority of those appeals succeeded in getting a full or partial reversal of the original denial. “The high frequency of favorable outcomes upon appeal raises questions about whether a larger…

Originally Published on https://squaredawayblog.bc.edu/

Kim Blanton Squared Away Blog Writer

I’m a veteran financial and economics reporter, most recently for The Boston Globe, who has also written for The Economist and other publications. I uncovered scandals during the savings and loan crisis in Texas back in the late 1980s, trekked around the world to cover finance and economics in the 1990s, and ventured into Boston neighborhoods to cover the recent subprime mortgage crisis.

While covering subprime mortgages, I began to see the importance of financial behavior and literacy. Wall Street excesses certainly fueled the crisis, but a poor understanding of complex financial products also played a major role. I interviewed dozens of homeowners in the grip of foreclosure who had agreed to home loans that they did not understand and that their brokers did not or could not explain to them. The consequences for these individuals – and the country – were disastrous.

I use the same dogged reporting skills to cover financial issues of growing importance today, including the personal crisis that concerns millions of baby boomers: Retirement.