Two senators have demanded that the three largest Medicare Advantage insurers turn over internal records showing exactly how they decide whether to pay for care after a hospital stay, including any use of algorithms or software to judge medical necessity.
The July 14 letters from Sen. Richard Blumenthal of Connecticut and Sen. Josh Hawley of Missouri went to UnitedHealthcare, Humana and CVS Health, and covered decisions on skilled nursing facilities, inpatient rehabilitation facilities and long-term acute care hospitals dating back to January 2023. The insurers were given until July 28 to respond.
The households at stake are specific. These are families deciding, often within 48 hours of a hospital discharge, whether a parent goes to a rehabilitation facility or comes home. A denial at that moment reshapes the decision, and federal auditors have found that most of those denials do not survive an appeal.
The Scope of What Is Being Asked
The senators, who sit on the Senate Permanent Subcommittee on Investigations, requested records on each company’s process for authorizing or covering post-acute care, an inventory of the predictive technologies each uses, and confirmation of whether it remains company policy that a final denial cannot be made by artificial intelligence.
That last question is the sharpest one. It asks the companies to restate a commitment on the record rather than in a press release.
In their letter to Humana, the senators wrote that without comprehensive reporting requirements, Medicare Advantage insurers “are able to hide the full extent of denials of care.” The subcommittee’s announcement framed the request as testing claims the companies have made since a 2024 subcommittee report that they are reducing prior authorization burdens.
What Federal Auditors Found First
The letters follow two reports published on June 8 by the Department of Health and Human Services Office of Inspector General, which examined prior authorization data from 19 Medicare Advantage insurers using June 2024 records.
One report found that UnitedHealthcare, Humana and CVS denied admission requests to long-term acute care hospitals and inpatient rehabilitation facilities at higher rates than their peers. The letter to UnitedHealthcare cited a finding that the company denied 66 percent of inpatient rehabilitation facility admission requests, against an average of 41 percent across 16 smaller insurers.
The second report found the three insurers collectively denied 12 percent of skilled nursing facility requests. Humana denied 13.5 percent of all such requests. Nearly all appealed denials were later overturned. Both reports flagged the role of NaviHealth, a utilization management vendor owned by UnitedHealth’s Optum unit.
The cost context is part of why insurers scrutinize these admissions. Medicare’s average cost for a post-hospital rehabilitation stay ranged from roughly $16,000 to $49,000 in 2023, and insurers argue that variation in price and quality among facilities justifies review. Both OIG reports are posted publicly.
That overturn rate is the number that matters most to families. A denial that gets reversed on appeal still delayed care while the appeal ran, and comparatively few patients file one.
The Limits of a Congressional Records Demand
A letter from a subcommittee is not a subpoena, not a regulation, and not a lawsuit. It carries no automatic penalty, and companies routinely respond with material designated confidential.
What an inquiry of this kind can produce is a public record. The subcommittee’s October 2024 report was built from more than 280,000 pages of internal documents obtained the same way, and it established the denial-rate comparisons that federal auditors later echoed. Documents gathered now could support a future public report, a hearing, or legislation.
What it cannot do is reverse anyone’s denial. No individual patient’s coverage decision changes because of this inquiry, and there is no timeline by which the subcommittee must publish anything.
Separate tracks are moving. The House Ways and Means Committee unanimously approved the Improving Seniors’ Timely Access to Care Act of 2026, which would standardize electronic prior authorization in Medicare Advantage and require plans to report denial rates to the federal government. The American Medical Association said the vote reflects recognition that prior authorization “too often stands between patients and their physicians.” Federal interoperability rules requiring faster prior authorization decisions also phase in through 2027.
The companies have not been found to have violated any law in connection with this inquiry, and the questions in the letters are allegations and requests rather than findings.
What Families Facing a Discharge Can Do Now
None of this changes the practical playbook for a household in the middle of a discharge decision, and that playbook is worth knowing before it is needed.
Ask the hospital case manager to put the recommended level of post-acute care in writing, with the clinical reasoning attached. That document becomes the backbone of an appeal. Request the denial in writing if one is issued, including the specific coverage criterion cited. File an appeal, and ask about an expedited appeal if the patient is still hospitalized or a delay would jeopardize recovery. Federal auditors found most appealed post-acute denials get overturned, which makes the appeal the single highest-value action available.
Families can also contact their State Health Insurance Assistance Program for free counseling, and can call 1-800-MEDICARE to report a problem.
Nobody should refuse recommended medical care because of a coverage dispute. Decisions about where a patient recovers belong with the clinical team, with the coverage question handled in parallel.
The subcommittee has not announced whether it will publish the material it receives or hold a hearing. MedicalDaily will report on any subcommittee findings, further OIG audits, or floor action on the prior authorization legislation.
Frequently Asked Questions
What did the senators actually ask for? Records on how each insurer decides post-acute care coverage, an inventory of predictive technologies used, and confirmation of whether final denials can be made by artificial intelligence.
Which insurers received the letters? UnitedHealthcare, Humana and CVS Health, the three largest Medicare Advantage organizations.
What did federal auditors find? Two June reports found the three insurers denied post-acute admission requests at higher rates than peers, and that nearly all appealed skilled nursing denials were later overturned.
Does this change anyone’s coverage? No. A congressional records request has no effect on an individual coverage decision.
What should a family do if post-hospital care is denied? Request the denial in writing with the criterion cited, ask the hospital case manager for written clinical reasoning, and file an appeal, including an expedited appeal if a delay would harm recovery.
Are the insurers accused of breaking the law? No. The letters request information and cite audit findings. No legal violation has been established in connection with this inquiry.
Is legislation moving? The House Ways and Means Committee approved the Improving Seniors’ Timely Access to Care Act of 2026, which would standardize electronic prior authorization and require denial-rate reporting. It has not become law.
