Medicare Advantage Insurers Boost Profits by Denying Seniors Necessary Care

A U.S. Senate subcommittee releases report detailing systemic prior authorization denials for post-acute care by the three largest Medicare Advantage insurers.

October 22, 2024 (Pearsall, Texas) – The three largest Medicare Advantage insurers systematically deny requests for post-acute care, skilled care for patients recovering after a hospital visit, according to a new report (https://www.hsgac.senate.gov/subcommittees/investigations/library/)  from the U.S. Senate Permanent Subcommittee on Investigations

“This report confirms what we’re seeing in our hospital and community,” said John Hughson, CEO Frio Regional Hospital. “Too many of our senior patients can’t get the care they need because their Medicare Advantage plan denies it, and our healthcare teams have to spend hours appealing the denial and trying to protect our patients’ health.”

“What we have found is, essentially, there is no advantage for people in Medicare Advantage, all too often,” Sen. Richard Blumenthal (D-C.T.), chair of the subcommittee, said in a statement.

The report summarizes the Subcommittee’s investigation into three Medicare Advantage insurers: UnitedHealthcare, CVS, and Humana – that together insure almost 60 percent of all Medicare Advantage enrollees.

The investigation found that:

• From 2020 to 2022, United Healthcare’s prior authorization denial rate for post-acute care more than doubled, from 10.9 percent to 22.7 percent.
• In 2022, Humana’s denial rate for post-acute care was more than 16 times higher than its overall denial rate.
• From 2020 to 2022, the number of requests for post-acute care that CVS subjected to prior authorization increased by 57.5 percent.

The Subcommittee’s investigation began in May 2023, when lawmakers sought clarity from the Medicare Advantage insurers on their prior authorization practices, including the companies’ use of artificial intelligence to increase the number of care denials.

“It’s critical that everyone who is eligible for Medicare get the facts and understand the full picture the differences between traditional Medicare and Medicare Advantage,” said John. “With open enrollment running now through December 7th, this is a great opportunity for seniors and their families to talk with their care teams and learn how Medicare Advantage could affect their ability to get the care they need.”

ABOUT FRIO REGIONAL HOSPITAL

Frio Regional Hospital has proudly served Pearsall and neighboring communities like Dilley and Divot since the 1960s, offering compassionate, high-quality care for both planned medical events and emergencies. Our mission is to improve the quality of life in our community by providing exceptional healthcare with respect and compassion. We are a full-service hospital offering emergency, acute, specialty, outpatient, home health, rehabilitation services, primary care and family medicine.