Sen. Ossoff Investigating Insurance Companies Denying Claims & Delaying Medically Necessary Health Care

Washington, D.C. - U.S. Senator Jon Ossoff is investigating insurance companies denying claims and delaying medically necessary health care.

In response to hearing from Georgians, Sen. Ossoff launched an inquiry with Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services (CMS), about insurance practices that lead to denied claims and delayed health care that patients need.

A recent Johns Hopkins study found that the practice of prior authorization, where patients must seek approval from their insurance company before receiving care, was "associated with disease exacerbation, preventable hospitalization, prolonged hospital stay, and lower rates of disease-free survival."

According to KFF, virtually all seniors enrolled in Medicare Advantage must obtain prior authorization for some services, and in 2024 over four million of these requests were denied.

Additionally, KFF also found that of the approximately 85 million Affordable Care Act (ACA) in-network denied claims in 2024, less than 1% were appealed, forcing patients either to pay for services out-of-pocket, despite having "coverage," or forgoing care - solely because of decisions made by insurance companies.

"The improper use of 'prior authorization,' where patients must seek approval from their insurance company before receiving care, has led to Georgians being denied life-saving medication and others who have been forced to wait months to get the care they need - all at the whim of insurance companies," Sen. Ossoff wrote to Administrator Oz.

Sen. Ossoff continues working to lower health care costs for Georgia families and take on the insurance companies.

In March, Sen. Ossoff cosponsored Ally's Act, bipartisan legislation first introduced by Sens. John Curtis (R-UT) and Elizabeth Warren (D-MA), which would help children with hearing loss get the care they need by requiring insurance providers to cover bone-anchored hearing systems and cochlear implants, as well as the surgery, maintenance, and upgrades associated with these devices.

In February, Sen. Ossoff worked with Republicans and Democrats to pass the Increasing Transparency in Generic Drug Applications Act to increase transparency in generic drug applications and reduce unnecessary delays so that these low-cost medications are brought to consumers faster.

The same month, the bipartisan Accelerating Kids' Access to Care Act, a bill cosponsored by Sen. Ossoff, was signed into law as part of bipartisan government funding legislation to ensure kids covered by Medicaid in Georgia face fewer delays when receiving specialty care.

Also in February, Sen. Ossoff cosponsored the bipartisan Safe Step Act, introduced by Sens. Lisa Murkowski (R-AK) and Maggie Hassan (D-NH), to help prevent insurance companies from delaying Georgians' access to medical care.

Click here to read Sen. Ossoff's inquiry.

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