Deadly Denials

Designed to prevent doctors from deploying expensive, ineffectual procedures, prior authorization 鈥 sometimes called pre-authorization or pre-certification 鈥 has become a confusing maze used by health insurance companies that denies or delays care, burdens physicians with paperwork, and perpetuates racial disparities. Proposed federal rules may not be enough to solve the problems.

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.

Biden Cracks Down on Prior Authorization 鈥 But There Are Limits

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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 鈥 a long-standing system that prevents many patients from accessing doctor-recommended care. 鈥淲hen a doctor says a patient needs a procedure, it is […]

Hospitals and Doctors Are Fed up With Medicare Advantage

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Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans 鈥 they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF鈥檚 count. But among doctors and hospitals, it鈥檚 a different story. Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans […]