Three Largest Medicare Advantage Organizations Had The Highest Denial Rates For Long-Term Acute Care Requests

Medicare Advantage organizations (MAOs) denied 65% of prior authorization requests for admission to long-term care hospitals (LTCH) and 54% of requests for admission to intermediate rehabilitation facilities (IRF) during the first half of 2024, according to a federal analysis of data from 19 MAOs during June 2024. The three largest MAOs by enrollment (CVS Health, Humana, and UnitedHealth) had the highest volume of prior authorization requests for these two post-acute settings issued denials at higher rates than other MAOs.

The denial rates for the three MAOs were as follows:

CVS Health Corporation denied 80% of 393 LTCH requests . . .