Centene, Aetna, Kaiser Lead in Medicare Advantage Denials: KFF

Modern Healthcare / By Nona Tepper

Aetna, Centene and Kaiser Permanente denied at least one in 10 Medicare Advantage prior authorization requests in 2023, according to a KFF analysis published Tuesday. 

Across the industry, Medicare Advantage insurers increased their use of prior authorization by 7.8% to 49.8 million total requests in 2023, the health policy think tank determined using Centers for Medicare and Medicaid Services data. The increase in requests is in line with enrollment growth, KFF said. Insurers denied slightly fewer prior authorization requests in 2023, refusing to cover 6.8% of claims compared with 7.4% in 2022. 

Related: Medicare Advantage prior authorization, marketing limits proposed

Legislators and regulators have called out the use of prior authorization in Medicare Advantage in recent years as a growing number of policyholders report confronting barriers to care, particularly in post-acute settings.

People in their last year of life were more than twice as likely to switch from Medicare Advantage to traditional Medicare over care access concerns, according to a 2021 report by the Health and Human Services Office of the Inspector General. Those switching from Medicare Advantage to traditional Medicare cost the federal government 27% more than those who were continuously enrolled in the fee-for-service program, KFF reported in December. At the same time, CMS has fined insurance companies for exaggerating patient conditions to improperly inflate federal reimbursements…

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