AI Will Soon Have a Say in Approving or Denying Medicare Treatments
A pilot program testing the use of artificial intelligence to expand prior authorization decisions in Medicare has providers, politicians, and researchers questioning Trump administration promises to curb an unpopular practice that has frustrated patients and their doctors.
Fighting a Health Insurance Denial? Here Are 7 Tips To Help
Many people don’t know they can fight a health insurance denial, let alone how to do it. Here are practical tips for consumers who want to appeal a prior authorization decision.
Doulas, Once a Luxury, Are Increasingly Covered by Medicaid — Even in GOP States
Even as states brace for significant reductions in federal Medicaid funding over the next decade, conservative legislatures across the country are passing laws that grant doula access to Medicaid beneficiaries.
5 Takeaways From Health Insurers’ New Pledge To Improve Prior Authorization
Dozens of health insurance companies pledged on Monday to improve prior authorization, a process often used to deny care. The announcement comes months after the killing of UnitedHealthcare executive Brian Thompson, whose death in December sparked widespread criticism about insurance denials.
‘Not Accountable to Anyone’: As Insurers Issue Denials, Some Patients Run Out of Options
Health insurers issue millions of prior authorization denials every year, leaving many patients stuck in a convoluted appeals process, with little hope of meaningful policy change ahead. For doctors, these denials are frustrating and time-consuming. For patients, they can be devastating.
Trump Won’t Force Medicaid To Cover GLP-1s for Obesity. A Few States Are Doing It Anyway.
Late last year, South Carolina Medicaid approved a class of medications known as GLP-1s to treat obesity, placing it among the few state programs covering these effective but expensive drugs. But access remains limited, even for patients covered by Medicaid, because of stringent prerequisites that must be satisfied before starting the drug.
The Patient Expected a Free Checkup. The Bill Was $1,430.
Carmen Aiken of Chicago thought their medical appointment would be covered because the Affordable Care Act requires insurers to pay for a long list of preventive services. But after the appointment, Aiken received a bill for more than $1,400.
‘They Won’t Help Me’: Sickest Patients Face Insurance Denials Despite Policy Fixes
The fatal shooting of UnitedHealthcare CEO Brian Thompson prompted both grief and public outrage about the ways insurers deny treatment. Republicans and Democrats agree prior authorization needs fixing, but patients are growing impatient.
Helicopters Rescued Patients in ‘Apocalyptic’ Flood. Other Hospitals Are at Risk, Too.
The helicopter evacuation of 70 people from a Tennessee hospital during Hurricane Helene is considered a success story. The building was destroyed by floodwaters, but no one died. In hindsight, why was it built next to a river?
In Chronic Pain, This Teenager ‘Could Barely Do Anything.’ Insurer Wouldn’t Cover Surgery.
An Alabama teen was told he needed surgery for debilitating hip pain. But his family’s insurer denied coverage for the procedure, which lacked a medical billing code. Expected to pay more than $7,000, his father charged it to credit cards.