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Another payor-provider breakup

What are hospital systems supposed to do if insurers refuse to play fair? As of February 1, Blue Cross Blue Shield of Arizona (BCBSAZ) is out of network with San Francisco-based Dignity… Read More

No surprises here: Insurers failing to uphold their end of the No Surprises Act

It seems simple: Established in 2022, the No Surprises Act seeks to limit the amount of out-of-pocket expenses that patients might get stuck with when their insurance company is out of network… Read More

Some insurance companies employ doctors with medical malpractice suits to review claims.

Where do doctors with malpractice claims go? In some cases, to insurance companies. To be sure, not all doctors working for insurance companies have faced malpractice suits, nor do all who have… Read More

Yet another health insurance company is using AI to deny medical claims.

It’s 2024, and AI is in the air — it’s everywhere. Especially in healthcare. Whether it’s imaging software that can help doctors quickly identify and diagnose diseases; predictive insights that help optimize… Read More

We don’t care, say insurers: Payors bypass state laws and deny care.

North Carolina. Oklahoma. Michigan. Maine. Arizona. California. These are just some of the states where health insurance companies are denying patients their due care — and, as a result, lawmakers are speaking… Read More

Another algorithm to say ‘no’ to your care

Nice try, UnitedHealthcare . . . The nation’s largest health insurer has recently found itself in hot water over an algorithm it uses to deny rehabilitation care for Medicare Advantage beneficiaries. According… Read More

Prior authorization reform? We’ll believe it when we see it.

You know when someone says they’re sorry only because they got caught? That’s what it feels like with health insurers and prior authorization reform. Even though some of the largest health insurance… Read More

The data keeps rolling in — claim denials continue to impact patient care

Health insurance companies continue to cook up creative strategies to shortchange health systems through underpayments, non-payments, and — it’s the big one! — claim denials. These strategies reduce what gets reimbursed to… Read More

Expect to be denied: Claim denials are on the rise

If there’s one thing you can count on in the American healthcare system, it’s claim denials. At least, that’s what the research tells us. According to a recent Kaiser Family Foundation (KFF)… Read More

Doctors and patients are getting loud online. Here’s why.

North Carolina resident Sally Nix has had enough with prior authorizations. Afflicted with a combination of autoimmune diseases since 2011, brain and spinal surgeries failed to relieve Nix’s chronic pain and fatigue.… Read More

Another survey reveals the dark underbelly of commercial health insurers

Back in July, the American Hospital Association (AHA) released findings from three surveys conducted by Morning Consult on the practices of commercial health insurers. The findings weren’t great. Patients, nurses, and physicians… Read More

Prior authorizations are (still) a bad idea.

We’ve said it before, and we’ll say it again: Prior authorizations are a bureaucratic bad idea. At least, they are for physicians and patients. But while prior authorizations can be a minor… Read More

UnitedHealthcare rolled back its prior authorization policy. But ‘advance notification’ might be even worse.

Earlier this spring, UnitedHealthcare (United) announced plans to effectively use prior authorizations as blockades to colonoscopies. Any patient seeking a surveillance or diagnostic colonoscopy to detect cancer would first need approval from… Read More

Hospitals are struggling as costs rise. Insurers aren’t helping.

Hospitals are struggling. And according to a new report from the American Hospital Association (AHA), health insurers aren’t doing anything to make it easier. In fact, they’re making it worse. After a… Read More

Big surprise: NC insurers push back on covering patient care

Like other states, many in North Carolina struggle to access quality healthcare. Several bills are in review by the state’s House Health Committee, many of which seek to improve access for patients… Read More

Good news: North Carolina expanded Medicaid. Bad news: It’s not a silver bullet.

FINALLY! North Carolina expanded Medicaid. After years of debate across the state, after months of pushing and pulling on both sides of the aisle, North Carolina Republicans finally passed Medicaid expansion. It’s… Read More

‘A system built to deny claims’: Insurer denials frustrate patients and providers

1.2 seconds. That’s how long it takes for ‘an expert’ at Cigna to look at your medical claim and determine the fate of your care. A whopping 1.2 seconds. They do it… Read More

Hospitals attempt to stay afloat amidst nasty contract negotiations

Every few years, contract negotiations between payors and providers pull back the curtain on the innerworkings of the American healthcare system. The findings are gruesome. For reference, a recent article in Becker’s… Read More

Prior authorizations are a bureaucratic bad idea

You’re probably familiar with the phrase, “The road to hell is paved with good intentions.” The same can be said of prior authorizations. Decades ago, prior authorizations were designed with a reasonable… Read More

1, 2, 3 . . . it’s a big jump to 273

Between 2018 and 2021, Wilmington, North Carolina resident Stephanie Christy was covered under an individual health plan sponsored by Blue Cross Blue Shield of North Carolina (BCBSNC). Until she wasn’t…and was left… Read More

Why is insulin so expensive? California alleges manufacturers and pharmacy benefit managers are gaming the system

Let’s be real: Insulin is already expensive. A 2021 RAND report found that insulin costs approximately 10 times more for Americans than it does in other countries. So, we don’t need drug… Read More

Wait…high-deductible plans prove dangerous for patients? No way!

Chronic conditions, such as diabetes, require management, care, and medications. When insurers create hurdles that directly or indirectly block access to care, those patients suffer. And apparently, that’s exactly what’s happening across… Read More

What good are medical advances if insurance won’t pay for them?

We’ve come a long way in modern medicine, especially when it comes to HIV care. In the mid-90s, life expectancy at age 20 for HIV-infected individuals was just 39 years old. Today,… Read More

Sugar and spice, not everything’s nice…

It’s the holiday season, a time for peace and goodwill, right? Well, not quite. Because it’s also the season for contract negotiations, err . . . disputes. And it looks like insurers… Read More

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