Denials Rose In 2024 As Insurers Asked For More Info, Medical Necessity
Modern Healthcare points out from the new report, however, that the initial denials were often overturned, and insurers ended up paying nearly 97% of dollars requested. Also in industry news: Florida Blue and Broward Health; Uber Health and Lyft Healthcare; medical errors and AI; and more.
Modern Healthcare:
Claim Denials Grew As Prior Authorization Rejections Fell In 2024
Health insurance companies initially declined to pay more than one dollar for every $10 providers submitted in claims last year, an increase from 2023. Payers in 2024 initially denied 11.8% of dollars associated with hospital-based claims, according a report from consultant Kodiak Solutions. That compares with 11.53% of dollars denied in 2023. (Tepper, 5/23)
Health News Florida:
Florida Blue, Broward Health Talks At An Impasse
The clock is ticking louder for Florida Blue policyholders as the insurer and Broward Health remain at an impasse on a new agreement after three months of negotiations. If no deal is reached, Broward Health will be out of network for Florida Blue customers after June 30, when the current hospital-insurer contract ends. (Mayer, 5/26)
Regarding Medicaid tax and cuts —
New Hampshire Public Radio:
State, Hospitals Settle Lawsuit Over Medicaid Tax
State officials and a group representing New Hampshire’s hospitals say they’ve settled a lawsuit over the state’s Medicaid Enhancement Tax – ending a year-long dispute that had threatened a key source of funding for the safety-net insurance program. (Cuno-Booth, 5/23)
Modern Healthcare:
Uber Health, Lyft Healthcare Face Headwinds Amid Medicaid Cuts
Proposed cuts to Medicaid could dampen the growth Uber Health and Lyft Healthcare have seen by aligning with the federal assistance program. A bill that would cut Medicaid and other programs by more than $1 trillion passed the House Thursday and moves to the Senate, where it faces a tough road to passage in its current form. The measure could reduce Medicaid enrollment by 7.6 million people, according to an estimate from the Congressional Budget Office. (Perna, 5/23)
Stat:
Hospitals Thrive In Q1, But Medicaid Cuts, Policy Shifts Cloud Future
Mickey Mouse wishes he had the profit margins of some hospitals. AdventHealth is currently more profitable than the average company within the S&P 500. The tax-exempt, religious system, which runs 53 hospitals across nine states, generated a 17% operating margin and 23% net margin, inclusive of investments, in the first three months of 2025. Its net margin was larger than that of Amazon, ExxonMobil, and, yes, Walt Disney. (Herman, 5/27)
In pharma and tech news —
Axios:
Just How Many Americans Are Taking GLP-1s Now
More than 2% of Americans are taking the blockbuster class of GLP-1 drugs for overweight or obesity, up nearly 600% over six years, according to a report from FAIR Health given to Axios first. The data from FAIR Health's repository of over 51 billion commercial healthcare claim records shows the explosion in use of the drugs specifically for weight loss — roughly half of all users. (Reed, 5/27)
NBC News:
Medical Errors Are Still Harming Patients. AI Could Help Change That
Despite ongoing efforts to improve patient safety, it’s estimated that at least 1 in 20 patients still experience medical mistakes in the health care system. One of the most common categories of mistakes is medication errors, where for one reason or another, a patient is given either the wrong dose of a drug or the wrong drug altogether. In the U.S., these errors injure approximately 1.3 million people a year and result in one death each day, according to the World Health Organization. (Cox, 5/25)
