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AAOS Endorses New Medicare Advantage Bill to Protect Patients and Physicians

On September 15, 2026, the American Association of Orthopaedic Surgeons (AAOS) expressed its support for the introduction of the Protecting Approved Care Act, a significant piece of legislation that seeks to address a critical issue within the Medicare Advantage (MA) program. This bipartisan bill, co-sponsored by Representatives Greg Landsman (D-OH) and Bob Onder (R-MO), aims to put an end to retroactive reimbursement changes imposed by insurers, commonly referred to as "clawbacks."

The Protecting Approved Care Act is designed to amend the Medicare statutes, mandating that MA organizations adhere to their original coverage decisions and preventing them from withdrawing payments already made. This legislative step is crucial in establishing a stable healthcare environment for both physicians and their patients, combating the unpredictability that clawbacks create.

The Issue of Clawbacks

Clawbacks result in a precarious situation for healthcare providers and patients, as they can occur even after services have been authorized. Traditionally, many Medicare Advantage insurers insist on prior authorization for procedures, which should theoretically secure approval for necessary care. However, numerous reports have surfaced where coverage is denied retrospectively, or payments are significantly reduced post-service delivery.

AAOS President Wilford K. Gibson, MD, FAAOS emphasized the profound financial implications of these clawbacks. He noted, "When insurance companies shift the coverage parameters after care has been rendered, it places an unanticipated financial burden on patients and physicians months or even years after the fact." The bill is seen as a critical move to hold insurers accountable and ensure they honor their original prior authorizations.

Impact on Physicians and Patients

One startling statistic from the American Medical Association indicates that 90% of physicians experience burnout directly related to the prior authorization process. The burdens associated with resolving disputes arising from clawbacks only exacerbate this issue, adding more administrative work onto already strained healthcare providers.

Moreover, the ramifications are severe for patients as well. Medicare Advantage enrollees often find themselves facing sudden, unexpected bills for services they believed would be covered. This unpredictability disproportionately affects low-income seniors and individuals with disabilities, many of whom depend on these plans for their healthcare needs. In fact, 36% of Medicare Advantage enrollees report earning less than $25,000 annually, underscoring the precarious position many find themselves in when healthcare payments are unexpectedly denied.

A Solution in Sight

As Dr. Gibson reflected, the consequences of clawbacks hinder the ability of physicians to deliver high-quality, timely care. The Protecting Approved Care Act promises to restore integrity to the prior authorization system and provide much-needed stability for both medical providers and patients navigating the complexities of healthcare.

The AAOS, stationed in Washington D.C. with outreach efforts in Rosemont, Illinois, is committed to advancing the interests of the orthopaedic community. The Office of Government Relations of AAOS actively advocates for healthcare policies that protect patient access and ensure physicians can provide optimal care without the looming threat of financial penalties from retroactive insurance practices.

For those interested in learning more about AAOS advocacy initiatives, more information is available on their official website. The AAOS encourages informed dialogue and engagement on legislative matters affecting musculoskeletal health, urging stakeholders across the spectrum to support initiatives like the Protecting Approved Care Act that promote fairness and responsibility within the healthcare framework.