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Insurer policies limit coverage and disrupt patient care, while producing record profits for corporate shareholders. Stay informed with the Un-covered newsletter.
Care and Access
Payors create administrative burdens and restrictive policies that prevent patients from accessing care and block providers from delivering it.
Are Health Insurers to Blame for Limited Access to Hospitals? Rural Health Systems Say Yes
These hospitals serve smaller, spread-out populations, keeping emergency departments open 24/7 and maintaining specialists on-call, all while facing unpredictable patient volumes and few commercial patients. The financial strain is immense, but instead… Read More
Luck of the draw: who is reviewing your health insurance claims?
Welcome to the Healthcare Lottery: your doctor orders a critical test and you assume the insurance you pay for will cover it. Instead, you get a letter saying it has been denied.… Read More
The Death of Brian Thompson: A Turning Point in Payor-Provider Negotiations
This is a difficult conversation to have. Brian Thompson’s passing is a loss. First and foremost to his family, friends, and colleagues who knew him personally. No matter your thoughts on the… Read More
‘Twas the Fight Before Christmas
It’s the holiday season—the time for good cheer, giving back, and counting our blessings. But while everyone else is focused on generosity, Anthem Blue Cross Blue Shield seems fixated on just the… Read More
Anthem’s Anesthesia Fiasco: A Window Into Years of Harmful Practices
Anthem just got caught trying to play doctor in the boardroom—again. Recently, the insurer proposed a policy that would let them decide how long patients “really” need anesthesia, essentially second-guessing trained physicians… Read More
Another payor-provider breakup
What are hospital systems supposed to do if insurers refuse to play fair? As of February 1, Blue Cross Blue Shield of Arizona (BCBSAZ) is out of network with San Francisco-based Dignity… Read More
No surprises here: Insurers failing to uphold their end of the No Surprises Act
It seems simple: Established in 2022, the No Surprises Act seeks to limit the amount of out-of-pocket expenses that patients might get stuck with when their insurance company is out of network… Read More
Some insurance companies employ doctors with medical malpractice suits to review claims.
Where do doctors with malpractice claims go? In some cases, to insurance companies. To be sure, not all doctors working for insurance companies have faced malpractice suits, nor do all who have… Read More
Yet another health insurance company is using AI to deny medical claims.
It’s 2024, and AI is in the air — it’s everywhere. Especially in healthcare. Whether it’s imaging software that can help doctors quickly identify and diagnose diseases; predictive insights that help optimize… Read More
We don’t care, say insurers: Payors bypass state laws and deny care.
North Carolina. Oklahoma. Michigan. Maine. Arizona. California. These are just some of the states where health insurance companies are denying patients their due care — and, as a result, lawmakers are speaking… Read More
Another algorithm to say ‘no’ to your care
Nice try, UnitedHealthcare . . . The nation’s largest health insurer has recently found itself in hot water over an algorithm it uses to deny rehabilitation care for Medicare Advantage beneficiaries. According… Read More
Prior authorization reform? We’ll believe it when we see it.
You know when someone says they’re sorry only because they got caught? That’s what it feels like with health insurers and prior authorization reform. Even though some of the largest health insurance… Read More
The data keeps rolling in — claim denials continue to impact patient care
Health insurance companies continue to cook up creative strategies to shortchange health systems through underpayments, non-payments, and — it’s the big one! — claim denials. These strategies reduce what gets reimbursed to… Read More
Expect to be denied: Claim denials are on the rise
If there’s one thing you can count on in the American healthcare system, it’s claim denials. At least, that’s what the research tells us. According to a recent Kaiser Family Foundation (KFF)… Read More
Doctors and patients are getting loud online. Here’s why.
North Carolina resident Sally Nix has had enough with prior authorizations. Afflicted with a combination of autoimmune diseases since 2011, brain and spinal surgeries failed to relieve Nix’s chronic pain and fatigue.… Read More
Another survey reveals the dark underbelly of commercial health insurers
Back in July, the American Hospital Association (AHA) released findings from three surveys conducted by Morning Consult on the practices of commercial health insurers. The findings weren’t great. Patients, nurses, and physicians… Read More
Prior authorizations are (still) a bad idea.
We’ve said it before, and we’ll say it again: Prior authorizations are a bureaucratic bad idea. At least, they are for physicians and patients. But while prior authorizations can be a minor… Read More
UnitedHealthcare rolled back its prior authorization policy. But ‘advance notification’ might be even worse.
Earlier this spring, UnitedHealthcare (United) announced plans to effectively use prior authorizations as blockades to colonoscopies. Any patient seeking a surveillance or diagnostic colonoscopy to detect cancer would first need approval from… Read More
Hospitals are struggling as costs rise. Insurers aren’t helping.
Hospitals are struggling. And according to a new report from the American Hospital Association (AHA), health insurers aren’t doing anything to make it easier. In fact, they’re making it worse. After a… Read More
Big surprise: NC insurers push back on covering patient care
Like other states, many in North Carolina struggle to access quality healthcare. Several bills are in review by the state’s House Health Committee, many of which seek to improve access for patients… Read More
Good news: North Carolina expanded Medicaid. Bad news: It’s not a silver bullet.
FINALLY! North Carolina expanded Medicaid. After years of debate across the state, after months of pushing and pulling on both sides of the aisle, North Carolina Republicans finally passed Medicaid expansion. It’s… Read More
‘A system built to deny claims’: Insurer denials frustrate patients and providers
1.2 seconds. That’s how long it takes for ‘an expert’ at Cigna to look at your medical claim and determine the fate of your care. A whopping 1.2 seconds. They do it… Read More
Hospitals attempt to stay afloat amidst nasty contract negotiations
Every few years, contract negotiations between payors and providers pull back the curtain on the innerworkings of the American healthcare system. The findings are gruesome. For reference, a recent article in Becker’s… Read More
Prior authorizations are a bureaucratic bad idea
You’re probably familiar with the phrase, “The road to hell is paved with good intentions.” The same can be said of prior authorizations. Decades ago, prior authorizations were designed with a reasonable… Read More