In a recent article for American Bar Association’s Health Law eSource, health care partner Mackenzie Wallace and associate Ashton Dietrich discuss the longstanding issue of prior authorization in Medicare Advantage plans and the harm it can cause to patients. It highlights examples of wrongful denials of medically necessary care by payers and the resulting delays and out-of-pocket costs for patients.
In response to these concerns, the Centers for Medicare & Medicaid Services (CMS) published a Final Rule in April 2023 to streamline prior authorization requirements for Medicare Advantage plans. The rule aims to prevent private insurance companies from wrongfully denying necessary care to seniors and people with disabilities.
Read more here.
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