OIG studies about Managed Care denials for rehab care after hospitalization

https://oig.hhs.gov/documents/audit/11694/OEI-09-24-00331.pdf (Skilled Nursing)

https://oig.hhs.gov/documents/audit/11693/OEI-09-24-00330.pdf (In Patient Rehab and Long-Term Acute Care.

"When SNF denials were appealed, MAOs overturned 95 percent in favor of the enrollee. The extremely high overturn rate indicates that some enrollees were initially denied medically necessary care and raises concerns about denials that were not appealed."

People often do not consider this when choosing their Medicare plan at the beginning of eligibility. But once in an Advantage plan, it's difficult to switch to original Medicare in many states without underwriting for Medigap coverage. They often do not realize the impact on their ability to receive rehab until they are hospitalized and need it--it seems very remote at age 65.

For all the people who have said here that Medicare Advantage denials for skilled, INR, or LTACH care is rare, think again.