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Consumer Problems with Prior Authorization: Evidence from KFF Survey
A KFF survey of adults with health insurance found that roughly 6 in 10 insured adults experience problems when they use their insurance. Problems examined include denied claims, network adequacy issues, preauthorization delays and denials, and others.
How Prior Authorization Makes Health Care a Nightmare
After experiencing mysterious hip and back pain for about six months, Dan Hurley finally went to see an orthopedist in December 2021. The diagnosis, after an MRI and a subsequent biopsy, was metastatic dedifferentiated chondrosarcoma, an aggressive cancer in his pelvic bone.
UnitedHealth abruptly reversed restrictions on Medicare rehab care
Health insurance giant UnitedHealth Group used secret rules to restrict access to rehabilitation care requested by specific groups of seriously ill patients, including those who lived in nursing homes or suffered from cognitive impairment, according to internal documents obtained by STAT.
A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her.
Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers,” Day said.
U.S. Opens UnitedHealth Antitrust Probe
The Justice Department has launched an antitrust investigation into UnitedHealth, owner of the biggest U.S. health insurer, a leading manager of drug benefits and a sprawling network of doctor groups.
Patients suffer at hands of insurance companies
OPINION – There is a brewing crisis in Orange County, one where the most vulnerable — seniors with disabilities, single mothers, families living below the poverty line — have lost access to vital health care services.
CMS rule sets deadlines for prior authorizations
Health insurance companies and states will have to resolve prior authorization requests more quickly under a final rule the Centers for Medicare and Medicaid Services published Wednesday.
How Medicare Advantage plans use AI to cut off care for seniors
An algorithm, not a doctor, predicted a rapid recovery for Frances Walter, an 85-year-old Wisconsin woman with a shattered left shoulder and an allergy to pain medicine.
UnitedHealth, Elevance, Centene earned big investment income in 2023
Health insurance companies had a terrific 2023 on Wall Street—as investors.
Health insurance premiums are eating into workers' wages
Families with workplace health insurance may have missed out on $125,000 in earnings over the past three decades as a result of rising premiums eating into their pay.
‘Breaking point’: Hospitals want Biden administration help with insurer care denials
The lobbying effort comes as more than a dozen health systems across the country no longer accept Medicare Advantage plans.
‘Make money by denying care’: new US rules aim to curb use of approval by private health insurances
Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem
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Claim denials cost hospitals $20 billion a year, report shows
Hospitals and health systems spend an estimated $19.7 billion a year managing denied claims for care, a new report shows.
A mom's $97,000 question: How was an air-ambulance ride not medically necessary?
“As parents, we did not make any of the decisions other than to say, ‘yes, we’ll do that,'” she said, “And…I don’t know how else it could have gone.”
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Hospitals say hundreds of local patients waiting to discharge over delayed health insurance approvals
Hospital association lawsuit targets Blue Cross for what it says are costly delays in granting nursing home and other ‘step down’ placements.
Unnecessary insurance claim denials compromise patient care and provider bottom lines
Health care providers are in an acute financial situation. Record-high wages required to attract and retain talent coupled with price inflation not seen since the early 1980s are driving higher costs, while reimbursement and federal policies limit providers’ ability to cover expenses.