US EditionStates try to rein in health insurers’ claim denials, with mixed results
- Due to increasing scrutiny over health insurance companies' prior authorization practices, which patients and doctors say cause harmful delays and denials of care, lawmakers in more than a dozen states are considering measures to regulate claims reviews and limit AI use.
- The increasing scrutiny stems from allegations that insurers use AI to deny necessary care without human review, as well as the high-profile killing of UnitedHealthcare CEO Brian Thompson, though there had been protests and outrage over the company's practices for months prior.
- According to a survey by the American Medical Association, 93% of doctors reported that insurers' prior authorization practices delayed necessary care, and 29% said these delays led to serious adverse events like hospitalization, permanent injury, or death.
- Dr. Mehmet Oz, during a March 14 confirmation hearing as President Trump's pick to lead the Centers for Medicare & Medicaid Services, defended the use of AI in reviewing claims, stating, 'AI can be used for good or for evil, and it to a large extent depends on whos using it and for what purpose,' while others like Timothy McBride emphasize the concentrated power of insurers.
- States like Pennsylvania, which passed bipartisan legislation in 2022 to streamline prior authorization, and Texas, which created a 'gold card' standard in 2021 exempting physicians with high approval rates from prior authorization, are attempting reforms, though only 3% of Texas physicians had achieved gold card status by the end of 2023, indicating mixed results and the need for further action.
78 Articles
78 Articles
United HealthCare, hospital system dispute harms patients, CT advocate says
As two giants in Connecticut’s health care industry approached a deadline Monday night that could jeopardize health care benefits for thousands of people, state Healthcare Advocate Kathleen Holt said consumers and patients are suffering no matter how the dispute resolves. “I think both sides leverage the fright they create. They’ve caused a lot of sleepless nights for people, and in the end they’ll both say ‘people should be grateful. Nothing to…
‘My life means so little’: Sickest patients face insurance denials despite policy fixes
HENRICO, Va. — Sheldon Ekirch spends a lot of time on hold with her health insurance company. Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful...
‘They won’t help me’: Sickest patients face insurance denials despite policy fixes
Sheldon Ekirch spends a lot of time on hold with her health insurance company. Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful and painful medical disorder.
'They won't help me': Why America's sickest patients still can't get healthcare they need
HENRICO, Va. — Sheldon Ekirch spends a lot of time on hold with her health insurance company. Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful and painful medical disorder.In 2023, Ekirch was diagnosed with small fiber neuropathy, a condition that makes her limbs and muscles feel as if they’…
kffhealthnews.org
‘They Won’t Help Me’: Sickest Patients Face Insurance Denials Despite Policy Fixes
HENRICO, Va. — Sheldon Ekirch spends a lot of time on hold with her health insurance company. Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful and painful medical disorder. In 2023, Ekirch was diagnosed with small fiber neuropathy, a condition that makes her limbs and muscles feel as if they…
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