ATLANTA — Reports of insurance companies delaying approval of medical treatments, or outright denying them for American patients, have prompted an investigation in the U.S. Senate.
U.S. Sen. Jon Ossoff wrote to Dr. Mehmet Oz, the Administrator of the Centers for Medicare and Medicaid Services, asking for an investigation into health insurance companies that delay or deny the treatments their patients need, to the detriment of their health.
According to a release from the senator’s office, a recent study from Johns Hopkins University showed that the practice of prior authorization was blocking or delaying care for patients.
Prior Authorization is when a patient and their doctor must have their medical insurance company approve a treatment before receiving care.
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Delays and denials of these treatments were “associated with disease exacerbation, preventable hospitalization, prolonged hospital stay and lower rates of disease-free survival,” according to the study.
An additional study from the Kaiser Family Foundation found that nearly all seniors enrolled in Medicare Advantage plans in the United States must obtain prior authorization for some services.
In 2024, more than four million were denied, KFF reported.
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KFF also reported that about 85 million patients on the Affordable Care Act’s in-network coverage had claims denied in 2024, and less than 1% of the denials were appealed.
That denial forced patients to either pay out of pocket even with insurance coverage, or simply go without the care they need, “solely because of decisions made by insurance companies.”
“The improper use of ‘prior authorization,’ where patients must seek approval from their insurance company before receiving care, has led to Georgians being denied life-saving medication and others who have been forced to wait months to get the care they need — all at the whim of insurance companies,” Sen. Ossoff wrote to Oz.
Ossoff wrote in his letter to Oz that he wants answers by April 30, related to how CMS tracks insurance denials, what the rate of successful appeal is, how improper denials can be reduced, and what enforcement actions CMS has for companies found to have “abusive denials or delays of care.”
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