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

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 today by the Department of Health and Human Services’ inspector general.

It comes amid increased scrutiny of how insurers use prior authorization, a cost-cutting tool that experts say often leads to the delay or denial of necessary care.

“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.”