Medicare Advantage plans denied 4.1 million services in 2024; only 10% appealed

Data shows Medicare Advantage plans issued 4.1 million prior authorization or payment denials in 2024. Of those, 80% were never appealed by patients or providers. For the 20% that were appealed, insurers reversed their decision four out of five times. The high reversal rate signals that a significant portion of initial denials may not be clinically justified. This trend places a greater operational burden on practices to track and appeal denials. Prioritize establishing a formal process for reviewing and appealing MA denials, as the success rate suggests it is a financially necessary step.