Unlawful Denial of Medically Necessary Audiologic Diagnostic Services—Medicare Advantage Claims
ADA is actively addressing widespread denials of medically necessary diagnostic audiology services by Anthem Medicare Advantage plans that began in mid-2025. Despite clear federal requirements that Medicare Advantage plans cover all medically necessary diagnostic audiology services, Anthem has denied claims across multiple states and improperly redirected providers to a third-party administrator that does not process these services. After repeated attempts to resolve the issue informally, ADA has issued a formal demand letter to Anthem and escalated the matter to the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS).