General Discussion

ions were initially denied fully or partially, and the vast majority were approved when doctor or other provider sends additional info.

Usually this is because the doctor's office did a poor job of requesting authorizations. For example, a doctor requests 3 additional hospital days for a patient that just finished an uncomplicated hernia operation. Insurer says pending additional info, we believe the 3 days aren't necessary for an uncomplicated hernia op. Then doc's office goes, oh chit we forgot to mention the patient developed pneumonia. Lets send in additional info. Almost always, that would be approved.

"In 2022, insurers fully or partially denied 3.4 million (7.4%) prior authorization requests. Though insurers approved most prior authorization requests, the share of requests that were denied jumped between 2021 and 2022. The share of all prior authorization requests that were denied increased from 5.7% in 2019, 5.6% in 2020 and 5.8% in 2021 to 7.4% in 2022."

https://www.kff.org/medicare/issue-brief/use-of-prior-authorization-in-medicare-advantage-exceeded-46-million-requests-in-2022/

Other examples would be a provider asks for approval for 14 encounters of physical therapy, but plan says 10 are sufficient -- usually based upon standards of care -- and we will reevaluate that if patient needs additional care as therapy approaches end.

In any event, the idea this justices killing someone is, well, trumpian. Call up your Congressman and tell them to enact legislation for a better healthcare system. I bet money they'll say -- if honest -- there is no way to enact health care reform that doesn't include private insurers.

Gallop Poll 2023

WASHINGTON, D.C. -- A 57% majority of U.S. adults believe that the federal government should ensure all Americans have healthcare coverage. Yet nearly as many, 53%, prefer that the U.S. healthcare system be based on private insurance rather than run by the government. These findings are in line with recent attitudes about the government’s involvement in the healthcare system, which have been relatively steady since 2015.

https://news.gallup.com/poll/468401/majority-say-gov-ensure-healthcare.aspx

And if you don't think doctors and hospitals cheat, spend a little time on this CMS/Medicare site:

https://oig.hhs.gov/fraud/enforcement/