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POLICY TOPIC

Denials and Appeals

Resources, analysis, and news coverage on this issue, all in one place.

About This Issue

Largely driven by prior authorization, MA and Part D coverage denials leave beneficiaries with only bad options: paying out-of-pocket, going without, or getting embroiled in a daunting and deeply flawed appeals process. Each path can lead to delayed care, abandoned therapies, worse health, and higher costs. Particularly egregious are improper coverage denials, which force people to make this choice unnecessarily.

Harmful denials must be curbed, and the appeals systems must be reformed to function as a safety valve—rather than as an inadequate substitute for sound plan decisions and robust federal oversight.

On This Issue

Resources, News & Coverage

30 items

  1. Medicare Watch The Use and Regulation of AI in Claims Review
  2. Medicare Watch New Public Data on Medicare Advantage Prior Authorization Shows Need for More Clarity
  3. Positions and Publications What Administrative Barriers Mean for Older Adults and People With Disabilities
  4. Medicare Watch Proposed Rule Would Improve Medicare Advantage Prior Authorization and Transparency
  5. Medicare Watch Medicare Rights Helpline Trends Report Highlights Beneficiary Challenges and Opportunities for Reform
  6. Press Release Medicare Rights Center Highlights Top Challenges for Medicare Beneficiaries in 2023 Trends Report 
  7. Positions and Publications Medicare Trends and Recommendations
  8. Medicare Watch Final Rule Codifies Observation Stay Appeal Rights
  9. Medicare Watch Medicare Advantage Denials Increased Before the Implementation of New Prior Authorization Rules
  10. Medicare Watch Final Rules on Medicare Advantage Prior Authorization Offer Improvements, but More Change is Needed
  11. Medicare Watch Study Shows Part D Plans Ratcheting Up Restrictions on Coverage
  12. Medicare Watch Coverage Experiences Vary for Original Medicare and Medicare Advantage Enrollees
  13. Medicare Watch Denied Insurance Claims Cause Issues for People with All Forms of Health Coverage
  14. Medicare Watch Medicare Rights’ Helpline Trends Report Shows Increasing Need for Help Affording Care
  15. Report 2022 Medicare Trends and Recommendations
  16. Comments Interoperability and Prior Authorization Proposed Rule
  17. Positions and Publications Medicare Part D Appeals Problems and Options to Correct Them
  18. Medicare Watch CMS Proposes Policy and Payment Changes for Medicare Advantage and Part D Plans
  19. Comments Comments on Proposed Changes to Medicare Advantage and Part D for Contract Year 2024
  20. Medicare Watch Medicare Rights Trends Report Shows Part D Enrollees Continue to Struggle with Costs and Other Barriers to Care
  21. Inside Medicare Rights Medicare Rights Trends Report Highlights Medicare Advantage and Part D Coverage Denials 
  22. Inside Medicare Rights Medicare Rights Advocates for Key Health Care Reforms in Congressional Budget Bill
  23. Medicare Watch Medicare Rights Urges Congress to Prioritize Critical Medicare Updates
  24. Medicare Watch Tell Congress to Strengthen Medicare
  25. Statements & Testimony Statement for the Record “Negotiating a Better Deal: Legislation to Lower the Cost of Prescription Drugs”
  26. Positions and Publications Reduce Barriers to Care
  27. Positions and Publications Summary of Policy Recommendations for the Biden Administration
  28. Letters Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) Letter of Support
  29. Positions and Publications Case Study: Streamlining Part D Appeals Process Act
  30. Positions and Publications Congress Must Streamline the Medicare Part D Prescription Drug Appeals Process

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