Backlash Over Coverage Denials Stings Private Medicare Plans

Medicare’s steady transition from its founding fee-for-service care model has hit a serious snag with the growing flap over coverage denials by the program’s private managed care plans.

By requiring plan approval, or “prior authorization,” before beneficiaries can receive certain health services, Medicare Advantage plans aim to reduce wasteful spending for unnecessary care, a problem that has dogged traditional Medicare for years.

In recent weeks, however, lawmakers, providers, patient advocates, and a government watchdog agency report have raised concerns that MA plans are using prior authorization to improperly deny medical care that fee-for-service Medicare typically covers. That includes provider requests ...