Payer Strategy & Health Insurance

The LI Daily: Prior Authorization: I Killed It Once. They Brought It Back. Now the Data Shows Why.

Prior Authorization: I Killed It Once. They Brought It Back. Now the Data Shows Why. A former health plan CMO followed the money — and the numbers are worse than the industry wants you to know. Archel...

More insurance claims denials are being overturned upon appeal, study finds

Study authors, who reviewed data from New York, said rising rates of overturned claims suggest that insurers’ claims review processes might not be working as intended, and policymakers should consider...

The Operational Drag of Prior Authorizations and the Moral Hazard Impact on Patients

Prior Authorization Is Source of Greatest Patient Burdens in the Health System, Poll Finds

Care delays and denials grow across 6 states using WISeR Model, lawmaker says

Traditional Medicare denials are harming patient care in the six states where the U.S. Centers for Medicare & Medicaid Services mandated the use of the Wasteful and Inappropriate Service Reduction (WI...

UnitedHealthcare Expands Rural Healthcare Initiatives, Reduces Prior Auth Requirements

UnitedHealthcare Expands Rural Healthcare Initiatives, Reduces Prior Auth Requirements  MedCity News

Treatment Delays, Denials More Common in Prescriptions Initially Rejected

Listen: With Little Federal Regulation, States Are Left To Shape the Rules on AI in Health Care

As artificial intelligence embeds itself into health care, some physicians and patient advocates worry it could be used by insurance companies to refuse payment for care. Maryland passed one law banni...

Data highlights gaps in finding in-network mental health coverage

Data highlights gaps in finding in-network mental health coverage  American Hospital Association

Elevance Health stock (US2855211023): Why does its managed care dominance matter more now for U.S. i

Elevance Health stock (US2855211023): Why does its managed care dominance matter more now for U.S. i  AD HOC NEWS