OIG Report: UnitedHealthcare, CVS, and Humana Deny Medicare Advantage Long-Term Care at Highest Rates
By
Joyce Frieden
Summary
An HHS Office of Inspector General (OIG) report reveals that major Medicare Advantage insurers—UnitedHealthcare, CVS Health (Aetna), and Humana—deny prior authorization requests for long-term care hospital (LTCH) and inpatient rehabilitation facility (IRF) care at significantly higher rates than other Medicare Advantage organizations. The report analyzed 19 Medicare Advantage plans and found that these three largest insurers had denial rates far exceeding their peers, raising concerns about patient access to critical post-acute and rehabilitative care.
Source
bskyOIG Report: UnitedHealthcare, CVS, and Humana Deny Medicare Advantage Long-Term Care at Highest Ratesmedpagetoday.comKey quotes
· 3 pulledAn HHS Office of Inspector General (OIG) report found that among 19 Medicare Advantage organizations, the three largest denied prior authorization requests for care in long-term care hospitals (LTCHs) and inpatient rehabilitation facilities (IRFs) at higher rates than most of their peers.
In some cases, high denial rates were driven by contractors that denied prior authorization requests at exceedingly high rates.
UnitedHealthcare, CVS Health, and Humana had the highest denial rates
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