U.S. Senator Richard Blumenthal D-Conn. criticized Medicare Advantage providers at a press conference in Hartford for denying coverage of essential post-acute care services, such as rehabilitative care and skilled nursing, through prior authorizations.
Blumenthal’s remarks followed a report from the U.S. Senate Permanent Subcommittee on Investigations, revealing that the three largest Medicare Advantage insurers—UnitedHealthcare, Humana, and CVS—reject post-acute care services at disproportionately high rates.
In 2022, UnitedHealthcare and CVS denied these services at triple the rate of other services, while Humana’s rate was 16 times higher.
Blumenthal condemned these denials as overriding medical professionals’ recommendations and causing harm to patients needing rehabilitation after surgeries or injuries.
He highlighted that while Medicare Advantage plans often have lower premiums, they demand prior authorizations, unlike traditional Medicare, which does not.
Insurers disputed the findings, claiming the report misrepresented their practices and that they already comply with CMS audits. UnitedHealthcare and CVS also noted that they provided feedback on the report, which they claim was ignored.
The report urged greater oversight, recommending CMS collect detailed data, conduct audits, and monitor artificial intelligence use in the prior authorization process. Blumenthal vowed to advocate for reforms, citing the urgent need to address these issues.