U.S. Sen. Richard Blumenthal, D-Conn., blasted Medicare Advantage providers at a press conference in Hartford on Thursday for denying coverage for certain services through prior authorizations.  Blumenthal’s criticisms stem from a report released the same day by the Democratic majority of the U.S. Senate Permanent Subcommittee on Investigations, which outlines how the three largest Medicare Advantage insurers — UnitedHealthcare, Humana, and CVS — reject coverage of post-acute care services at higher rates than other services. These include rehabilitative services at skilled nursing facilities, inpatient rehabilitation facilities and long-term acute care hospitals that help people recover following, for example, a bad fall or a surgical procedure that impacts their mobility. The report found that in 2022, UnitedHealthcare and CVS denied prior authorization requests for post-acute care services at triple the rate that they denied other services. Humana denied these services at 16 times the rate of other services. “These denials overrule the recommendations of the medical care providers who say that patients need the rehabilitation care or skilled nursing facility or post-acute, long-term hospital care. These kinds of denials are absolutely outrageous,” said Blumenthal.  Medicare Advantage is a type of Medicare plan offered by a private company, and it’s come to dominate the market. Both nationally and in Connecticut, over half of Medicare beneficiaries are enrolled in Medicare Advantage as opposed to traditional Medicare. Together, the three companies highlighted in the report account for 60 percent of all Medicare Advantage enrollees. These plans often have lower premiums, but, among other concerns cited by critics, they require beneficiaries to obtain prior authorization for certain services, including some that are typically higher cost.  “[Traditional] Medicare has no prior authorization. Period. End of story. Which is why Medicare Advantage has more disadvantages for a lot of seniors than advantages,” said Blumenthal. Spokespeople with CVS Health and Humana said the report mischaracterizes their use of prior authorization. They also said the insurers provided feedback to the committee on what they saw as errors in the report, and that the feedback was not ultimately incorporated. Spokespeople with CVS Health and UnitedHealthcare said that insurers already undergo audits regarding prior authorization and review of policies impacting post-acute care by the Centers for Medicare and Medicaid Services, or CMS. “This majority staff report mischaracterizes the Medicare Advantage program and our clinical practices, while ignoring CMS criteria demanding greater scrutiny around post-acute care,” said Heather Soule, a spokesperson with UnitedHealthcare, in an emailed statement, adding that Medicare Advantage members experience lower out-of-pocket costs, lower rates of avoidable hospitalizations, and very high satisfaction ratings. “We provided extensive feedback to the committee on these errors, which unfortunately were not addressed in the final report,” stated Phillip Blando, a CVS Health spokesperson. “This is a partisan report laden with errors and misleading claims. In fact, Senator Blumenthal’s team declined to correct those errors and mischaracterizations that Humana identified after reviewing certain heavily redacted excerpts prior to the report’s release,” stated Kevin Smith, a Humana spokesperson.   Blumenthal addressed these concerns at the press conference.  “It’s their data, it’s their internal documents. It’s their information that we’re relying on here,” he said. “If they’ve got better information, they should give it to us.” The report also stressed the importance of monitoring the use of artificial intelligence in prior authorization processes. Another major finding highlighted that UnitedHealthcare’s denial rate of post-acute care prior authorization requests rose from 8.7% in 2019 to 22.7% in 2022, during which time the company was launching initiatives to automate the certain steps in the prior authorization process.  Final recommendations from the report’s authors included that CMS should collect prior authorization information broken down by service category, conduct targeted audits of prior authorization data, and expand monitoring regarding the use of predictive technologies in prior authorization decision-making. “This prior authorization practice needs to have some safeguards and guardrails to make sure that these abuses are stopped. Reform is imperative. It’s urgent, and I will advocate for legislation that ensures that there are reforms in Medicare Advantage going forward,” said Blumenthal.