Bram Sable-Smith

States Get in on the Prior Authorization Crackdown

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Last month, my colleague Lauren Sausser told you about the Biden administration鈥檚 crackdown on insurance plans鈥 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鈥 鈥楶rior Authorization鈥 Red Tape

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Doctors, patients, and hospitals have railed for years about the prior authorization processes that health insurers use to decide whether they鈥檒l pay for patients鈥 drugs or medical procedures. The Biden administration announced a crackdown in January, but some state lawmakers are looking to go further.

Ohio Votes on Abortion Rights Today. Eleven States May Follow in 2024.

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Voters in Ohio are deciding whether to add abortion rights protections to the state鈥檚 constitution today.  The vote comes on the heels of last year鈥檚 string of ballot measure wins for abortion rights in six states: California, Kansas, Kentucky, Michigan, Montana and Vermont. But this is just the start. Next year, 11 more states could see abortion-related […]

Funyuns and Flu Shots? Gas Station Company Ventures Into Urgent Care

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A Tulsa-based gas station chain is using its knowledge of how to serve customers and locate shops in easy-to-find spots to enter the urgent care industry, which has doubled in size over the past decade. Experts question how the explosion of convenient clinics will affect care costs and wait times.

A Medical Cost-Sharing Plan Left Pastor With Most Of The Cost

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Jeff and Kareen King joined a medical cost-sharing plan advertised as a “refreshing non-insurance approach” to paying for health care. It had a big proviso: Preexisting conditions like Jeff’s heart condition were not fully covered for the first two years. He needed heart surgery after just 16 months.

Cuando hay mala praxis en centros de salud comunitarios, pagan los contribuyentes

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Los 1,375 centros de salud financiados con dinero federal, que atienden a 30 millones de estadounidenses de bajos ingresos, son en su mayor铆a organizaciones privadas. Sin embargo, reciben $6,000 millones anuales en subvenciones federales y, seg煤n la ley federal, sus responsabilidades legales est谩n cubiertas por el gobierno

When Malpractice Occurs at Community Health Centers, Taxpayers Pay

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Federally funded clinics and their doctors are protected against lawsuits by federal law, with taxpayers footing the bill. The health centers say that allows them to better serve their low-income patients, but lawyers say the system handcuffs consumers with a cumbersome legal process and makes it harder for the public to see problems.

This Open Enrollment Season, Look Out for Health Insurance That Seems Too Good to Be True

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Complaints about misleading health insurance marketing are soaring. State insurance commissioners are taking notice. They鈥檝e created a shared internal database to monitor questionable business practices, and, in the future, they hope to provide a public-facing resource for consumers. In the meantime, consumers should shop wisely as open enrollment season begins.