Ascension Supports New Legislation to Address Delays and Denials in Medicare Advantage Plans

Ascension, one of the nation's leading nonprofit and Catholic health systems, today announced its support for the Medicare Advantage Improvement Act (H.R. 8375), legislation aimed at addressing persistent barriers to timely, appropriate care for seniors enrolled in Medicare Advantage.

While Medicare Advantage was created to deliver better benefits and lower costs for seniors, too many patients face unnecessary delays, denials, and hurdles that interfere with timely and necessary care.

"Medicare Advantage was intended to provide more options and improve outcomes for seniors, but in too many cases it is creating new barriers," said Eduardo Conrado, President and CEO of Ascension. "Our physicians and care teams see it every day. Prior authorizations and inappropriate denials delay care and create confusion when patients need clarity and support most."

Ascension's experience reflects a growing concern across the healthcare industry. Internal data shows Medicare Advantage plans are 70 percent more likely than traditional Medicare to deny claims due to incomplete medical records and twice as likely to deny claims based on medical necessity. While a significant majority of these denials are overturned on appeal, they still result in delayed treatment, increased administrative burden on clinicians, and unnecessary stress for patients and families.

The Medicare Advantage Improvement Act seeks to address these challenges through targeted reforms, including:

• Improve timely access to care by reducing undue delays tied to prior authorization and inappropriate denials
• Strengthen oversight and transparency so patients can make informed coverage decisions
• Align coverage standards more closely with traditional Medicare to reduce unexpected patient costs
• Prevent misuse of AI-driven tools that increase inappropriate claim denial rates
• Streamline processes to ensure timely and accurate payments to providers

"For clinicians, the most important relationship in healthcare is the one between the patient and the care team," said Dr. Tom Aloia, Executive Vice President and Chief Clinical Officer at Ascension. "This legislation takes meaningful steps to reduce interference by insurance companies, respect the independent clinical judgment of providers, and ensure patients receive the right care at the right time. It allows us to spend less time navigating red tape and more time caring for people."

Ascension has taken steps within its own system to help patients and providers navigate Medicare Advantage, including dedicated support resources for clinicians and tools to help patients better understand their coverage options. However, internal efforts alone cannot fully address structural challenges within the program.

"We are committed to being part of the solution," Conrado added. "This legislation is an important step toward strengthening the doctor-patient relationship, improving transparency, and helping Medicare Advantage better serve seniors and the clinicians who care for them."