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News
Insurers Are Rejecting More Prescriptions Than Ever, New Study Finds
8+ hour, 5+ min ago (365+ words) A new study published in JAMA puts hard numbers behind something patients and doctors have been telling me for years: getting a prescription filled increasingly means running an obstacle course of denials, prior authorization forms, and step therapy requirements — and…...
UnitedHealth Helped Write the Law It Now Blames for Your Rising Premiums
1+ day, 53+ min ago (518+ words) shedding more than 1.5 million of its health plan enrollees and spending a considerably smaller percentage of its customers’ premiums paying claims than it did in the same quarter last year. The company also continued to take advantage of being able…...
Cigna’s Express Scripts Pressured Over TRICARE Contract in Senate Hearing
2+ day, 3+ hour ago (547+ words) A Senate Armed Services Subcommittee on Personnel hearing last week highlighted growing concerns about the Pentagon’s relationship with Cigna’s Express Scripts, the pharmacy benefit manager (PBM) that oversees the military’s TRICARE pharmacy program. During the hearing, Sen. Elizabeth Warren (D-Mass.)…...
CMS Slaps Its Own A.I. Contractor in Controversial WISeR Program
2+ week, 5+ day ago (373+ words) Private insurance companies use prior authorization extensively in the Medicare Advantage plans they own and operate, resulting in delays and denials of care that have been documented in numerous reports by government watchdog agencies. Until the WISeR program was launched…...
Elevance Had to Give $342 Million Back to Taxpayers
3+ week, 3+ hour ago (249+ words) Elevance Health, one of the nation’s biggest health insurance conglomerates, wired more than $342 million to the Centers for Medicare & Medicaid Services a few weeks ago after the agency threatened to suspend enrollment in the company’s Medicare Advantage plans over what…...
Federal Fraud Watchdog Documents How Medicare Advantage Fails People When They Are Most Vulnerable
1+ mon, 1+ week ago (635+ words) When my mother broke her hip, I watched a Medicare Advantage plan try to cut her recovery short. I knew enough from my years in the industry to fight back — and eventually I got her out of that plan entirely…...
Government Watchdog Agency Finds that Every High-Risk Acute Stroke Diagnosis Submitted by Medicare Advantage Insurers in Audit Was Upcoded
1+ mon, 2+ week ago (655+ words) HEALTH CARE un-covered Government Watchdog Agency Finds that Every High-Risk Acute Stroke Diagnosis Submitted by Medicare Advantage Insurers in Audit Was Upcoded A new federal audit found Medicare Advantage insurers received hundreds of millions in taxpayer dollars for stroke diagnoses…...
AI Gatekeepers in Medicare: WISeR Model Draws Fire for Delays and Denials
2+ mon, 3+ week ago (259+ words) A deep dive into prior authorization’s toll — from doctors to federal policy—featuring Dr. Wendy Dean, Dr. Seth Glickman and Rep. Suzan DelBene (D-WA) on CMS’s new AI-driven WISeR model. Thanks for reading HEALTH CARE un-covered! This post is public…...
Introducing The Health Insurance Influence Tracker
3+ mon, 1+ week ago (175+ words) Today, the Center for Health and Democracy Education Fund is launching a new tool, the Health Insurance Influence Tracker, as part of our ongoing work examining how giant health insurers have skewed the U.S. health care system away from working people…...
WSJ's Editorial Board Contradicts What Its Newsroom Has Reported on Medicare Advantage
3+ mon, 1+ week ago (742+ words) The paper that exposed Medicare Advantage’s $50 billion overbilling scheme is now urging the government to make it the default for every senior in America. During my two decades working for Big Insurance, I learned what industry spin looks like. I…...