Congressional Democrats are investigating Medicaid prior authorization practices and denied claims by private health insurers.
According to a federal report, one out of every eight requests for prior authorization of services by Medicaid Managed Care Organizations were denied in 2019.
Eve Marcum-Atkinson, director of health care advocacy for the West Virginia Citizen Action Group, said residents cannot get pacemakers, medication, or the surgeries they need, with serious consequences for community health.
“In the state of West Virginia, according to a report from the Health and Human Services Department, 13.7% of claims are denied,” Marcum-Atkinson reported.
According to the group People’s Action, private insurance companies deny more than 248 million claims or pre-authorization requests from their policyholders annually.
Marcum-Atkinson added groups want transparency and accountability from insurers, and tighter government oversight of company practices, among other reforms.
“We want them to audit and reimburse federal and state governments for the public money diverted by claims and prior authorization denials within Medicaid and Medicare,” Marcum-Atkinson emphasized.
According to a recent KFF survey, one in five Medicaid enrollees said they have experienced issues with prior authorization, higher than most other types of insurance, and close to a quarter said their health got worse because of insurance problems.