After Series of Denials, His Insurer Approved Doctor-Recommended Cancer Care. It Was Too Late.
Eric Tennant’s doctors recommended histotripsy, which would target, and potentially destroy, a cancerous tumor in his liver. But by the time his insurer approved the treatment, Tennant was no longer considered a good candidate. He died in September.
Paciente evita la enfermedad de Lyme, pero recibe una factura sorpresa
El personal de una clínica de urgencias encontró otra garrapata en el cuerpo de Leah durante esa visita. Pero su aseguradora no quiso pagar por el tratamiento.
La inteligencia artificial pronto influirá en que te aprueben o te nieguen tratamientos en Medicare
Siguiendo el ejemplo del sector privado de seguros, la administración Trump lanzará el próximo año un programa piloto.
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.
Deny and Delay? California Seeks Penalties for Insurers That Repeatedly Get It Wrong
A state lawmaker wants health insurers to disclose denial rates and explain those denials as anger grows over rising costs and uncovered medical care. If the bill is signed into law, health experts say, it could be one of the boldest attempts in the nation to rein in denials.
Montana Looks To Regulate Prior Authorization as Patients, Providers Decry Obstacles to Care
Patients and providers say health insurers’ preapproval requirements lead to delays and denials of needed medical treatments. Insurers argue that prior authorization keeps costs down.
States Get in on the Prior Authorization Crackdown
Last month, my colleague Lauren Sausser told you about the Biden administration’s crackdown on insurance plans’ prior authorization policies, with new rules for certain health plans participating in federal programs such as Medicare Advantage or the Affordable Care Act marketplace. States are getting in on the action, too. Prior authorization, sometimes called pre-certification, requires patients […]
States Target Health Insurers’ ‘Prior Authorization’ Red Tape
Doctors, patients, and hospitals have railed for years about the prior authorization processes that health insurers use to decide whether they’ll pay for patients’ drugs or medical procedures. The Biden administration announced a crackdown in January, but some state lawmakers are looking to go further.
Biden Cracks Down on Prior Authorization — But There Are Limits
More than a year after it was initially proposed, the Biden administration announced a final rule yesterday that will change how insurers in federal programs such as Medicare Advantage use prior authorization — a long-standing system that prevents many patients from accessing doctor-recommended care. “When a doctor says a patient needs a procedure, it is […]
Will CMS Crack Down on Prior Authorization?
There’s the Idaho doctor whose infant daughter developed a brain tumor. A woman in Southern California who waited months for an MRI before dying in the hospital. And a North Carolina patient who has trigeminal neuralgia — a condition so painful it’s commonly called the “suicide disease.” They all have something in common, aside from […]
Older Americans Say They Feel Trapped in Medicare Advantage Plans
As enrollment in private Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.
Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions
Even people with good insurance aren’t guaranteed affordable care, as this KFF Health News follow-up to one patient’s saga shows.
Cancer Patients Face Frightening Delays in Treatment Approvals
Delaying cancer treatment can be deadly — which makes the roadblock-riddled process that health insurers use to approve or deny care particularly daunting for oncology patients.
Hospitals and Doctors Are Fed up With Medicare Advantage
Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans — they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF’s count. But among doctors and hospitals, it’s a different story. Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans […]
Doctors and Patients Try to Shame Insurers Online to Reverse Prior Authorization Denials
Prior authorization is a common tool used by health insurers for many tests, procedures, and prescriptions. Frustrated by the process, patients and doctors have turned to social media to publicly shame insurance companies and elevate their denials for further review.
