Walnut Hill Study Exposes Systemic Medicare Advantage Barriers Causing Delays, Denials, and Patient Abandonment

, /PRNewswire/ -- Walnut Hill Medical has released findings from its MAD (Medicare Advantage Denial) Study, revealing that Medicare Advantage plans are systematically delaying or denying access to a non-opioid, non-steroidal chronic pain treatment: Peripheral Nerve Stimulation (PNS).

Based on a proprietary dataset of 1,210 Medicare Advantage patients who sought prior authorization for PNS in 2024, the study paints a troubling picture—raising urgent concerns about transparency, equity, and access in America's most popular form of Medicare coverage.

"Prior authorization isn't just a bureaucratic hurdle—it's being weaponized to deter care," said Chris Hanna, CEO of Walnut Hill Medical. "Transparency is the first step toward accountability."

Understanding the Issue: What Is Medicare Advantage and Prior Authorization?

Medicare Advantage (Medicare Part C) is a private alternative to traditional Medicare, now covering over half of all Medicare beneficiaries. These plans are managed by private insurers and often tout extra benefits—but they also impose stricter controls, including prior authorization (PA) requirements for many medical services.

Prior authorization requires providers to obtain insurer approval before delivering care. While designed to ensure medical necessity and control costs, PA can also result in significant care delays—or outright denials.

The 2022 Warning That Went Unheeded

In 2022, the Office of Inspector General (OIG) found that 13% of denied services in Medicare Advantage met Medicare coverage criteria and should have been approved. The OIG warned that plans may be inappropriately restricting access to necessary care.

Walnut Hill's 2024 data show the problem is even worse—especially for patients seeking advanced therapies like PNS.

Key Findings: Denials, Drop-Off, and Delays in Pain Treatment Access

PNS is a minimally invasive, FDA-cleared therapy for chronic pain. Walnut Hill's study found:

• 29% of patients were denied on their first prior authorization attempt—more than twice the OIG's 2022 benchmark.
• 28% of patients abandoned care after an initial denial—never appealing or resubmitting.
• Among those who appealed:
  • 56% had their denial overturned.
  • 69% who escalated to a Medicare hearing (OMHA) were approved.

"This isn't just inefficiency," Hanna said. "It's a sorting mechanism that weeds out patients without time, resources, or strong clinical advocates."

The Cost of Denial: Financial Incentives and Patient Harm

Of the 1,210 patients studied, 210 were denied and never received their PNS therapy. Based on 2024 Medicare Advantage reimbursement rates, Medicare Advantage plans withheld $6.2 million worth of care from patients—highlighting how administrative attrition reduces cost at the patient's expense.

A Call for Oversight and Reform

"Medicare Advantage now covers the majority of eligible seniors," said Hanna. "With that dominance must come responsibility. Our data show that without reform, prior authorization becomes a silent gatekeeper—not just delaying care but denying it altogether."

Walnut Hill is urging lawmakers to strengthen transparency and accountability provisions in the bipartisan Improving Seniors' Timely Access to Care Act of 2025, introduced by Rep. Mike Kelly (R-PA).

Download the Full Report

The complete MAD Study, including detailed methodology, statistics, and patient-level analysis, is available here: MAD-Study.WalnutHillMedical.com

About Walnut Hill Medical

Walnut Hill Medical partners with medical device companies, providers, life sciences organizations, and patients to deliver expert reimbursement strategy, health policy insights, and seamless prior authorization support. Their mission: Empower innovators to deliver care, enable doctors to focus on patients, and help patients access the therapies they need—without administrative barriers.

Resources:

Walnut Hill Medical MAD Study: https://mad-study.walnuthillmedical.com/

Full OIG Report: https://oig.hhs.gov/documents/audit/10207/A-05-24-00015.pdf

Improving Seniors' Timely Access to Care Act of 2025: https://regrelief.org/wp-content/uploads/2025/05/KELLPA_028_xml.pdf

Media Contact:
Grace Cuillier
Director of Strategy
[email protected]

SOURCE Walnut Hill Medical