As corporate insurance companies continue to delay and deny necessary care, a proposed new quality measure for the Medicare Advantage (MA) star ratings system would bring needed transparency and oversight to corporate insurers’ delay and denial of care within MA plans.
The Level 1 Upheld Denial Rate Measure would require corporate insurers to report the percentage of initial MA plan denials that are upheld, overturned or partially overturned, providing transparency into corporate insurers’ inappropriate patterns of care denial and allowing the Centers for Medicare & Medicaid Services (CMS) to hold corporate insurers accountable.
As of now, corporate insurance companies face no consequences for arbitrary denials of care for Medicare Advantage beneficiaries, even when they go directly against the best interests of patients. An investigation by NBC News found that corporate insurers who charge the Medicare program to cover seniors “routinely reject claims for necessary care.”
Not only are corporate insurance companies putting profits ahead of patients through excessive and unnecessary prior authorization practices – including denying more than two million Medicare Advantage claims in 2021 alone – a recent report by the Medicare Payment Advisory Commission (MedPAC) reveals that corporate insurers are projected to cost taxpayers $88 billion more in 2024 through the Medicare Advantage program than the government spends on Traditional Medicare.
As corporate insurance companies continue to boost their profits by routinely delaying and denying necessary care, policymakers must protect patients and hold corporate insurers accountable for abusive practices. The proposed new Level 1 Upheld Denial Rate Measure is an important step toward holding corporate insurers accountable and ensuring that patients have access to quality care when they need it.