U.S. Sen. Jon Ossoff is turning up the heat on health insurers, pressing the nation’s top Medicare and Medicaid official to investigate whether companies are using red tape to delay or block care for patients, including many in Georgia. He has also put the agency on a firm deadline, demanding detailed answers on how it tracks denials, appeals and enforcement.
Ossoff's Letter And The Deadline
In a public release, Ossoff said he had written to Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz, urging the agency to “investigate health insurance companies that delay or deny the treatments their patients need” and setting an April 30 response date, according to WSB‑TV. The letter presses CMS to spell out how it monitors denials, the rate at which patients successfully appeal them, and what enforcement actions are available when insurers engage in what Ossoff calls “abusive denials or delays of care.”
Research Links Prior Authorization To Harm
Ossoff’s push lands on top of mounting clinical concerns about prior authorization, the insurer requirement that doctors secure approval before delivering certain tests, drugs or procedures. A Johns Hopkins review found that prior authorization requirements have been associated with worse outcomes, including disease exacerbation, preventable hospitalizations, longer inpatient stays and lower disease‑free survival in cancer care, highlighting the clinical risk when treatment is delayed, according to Johns Hopkins Medicine. Surveys of physicians show widespread concern that prior authorization causes delays and, in some cases, leads patients to simply walk away from recommended treatment, per the American Medical Association.
How Big The Problem Is
The scale of denials is not small change. A Kaiser Family Foundation analysis of federal data found that Medicare Advantage plans fully or partially denied roughly 4.1 million prior‑authorization requests in 2024, while Affordable Care Act marketplace insurers denied about 85 million in‑network claims that year, according to KFF. Fewer than 1% of those denials were appealed. Those numbers line up with real‑world stories of patients who either pay out of pocket when they can or skip care altogether when their coverage is refused.
CMS Pushes Reform, But Questions Remain
Federal officials are not starting from zero. Last year, the Department of Health and Human Services and CMS brought major insurers to the table and secured a voluntary pledge to simplify and scale back prior‑authorization requirements, including more electronic submissions, fewer codes subject to prior review and broader real‑time approvals, according to a CMS release. The agencies said they would monitor how well insurers follow through and would consider regulatory action if needed. Patient advocates and clinicians, though, have cautioned that a voluntary pledge might help at the margins but will not necessarily stop improper denials without stronger enforcement and clearer transparency.
What This Means For Georgians
Ossoff has framed the issue in very local terms. In his letter, he wrote that “The improper use of ‘prior authorization’ ... has led to Georgians being denied life‑saving medication” and warned that denials have forced some patients to reach for their wallets or go without care entirely, according to WSB‑TV. He is asking CMS to lay out, in plain detail, what enforcement tools it uses and to provide data on appeals and improper denials so lawmakers and the public can judge whether federal oversight is actually protecting patients.
What Comes Next
Now CMS has a relatively short window to respond to the senator’s questions while also keeping tabs on insurer commitments. The agency has said it will evaluate insurer performance and, if the voluntary pledge falls short, is prepared to take additional steps, per CMS. Patients, health care providers and advocates will be watching closely to see whether the agency’s answers, and any follow‑up actions, actually translate into faster approvals and fewer harmful denials at the pharmacy counter and in the exam room.
