Evidence

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

Insurers will do just about anything to make a buck. Including taking money owed to physician practices and hospitals. According to an article from ProPublica, insurers take cuts from physician reimbursements if… Read More

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

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

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

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. 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

Ever wonder how hospitals and doctors’ offices get paid for the services they provide? Many of us know that insurers pay for some of the care patients receive, but how does a… Read More

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

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

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

Whoops, Blue Cross Blue Shield of North Carolina (BCBSNC) – you almost had us. The state’s largest health insurer is attempting to reorganize its business structure . . . which, conveniently, will… Read More

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

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

Between 2018 and 2021, Wilmington, North Carolina resident Stephanie Christy was covered under an individual health plan sponsored by Blue Cross Blue Shield of North Carolina (BCBSNC). Until she wasn’t…and was left… Read More

“Not medically necessary.” Says who…a doctor? No…an insurance company. And the insurance company here isn’t just any insurance company: we’re talking about UnitedHealthcare, the largest insurance company in the country. A company… Read More

Almost anyone can relate to or identify with the terms, ‘projection’ and ‘deflection’ — the experience of projecting your thoughts, feelings, and insecurities onto another person, and deflecting the blame away from… Read More

Let’s be real: Insulin is already expensive. A 2021 RAND report found that insulin costs approximately 10 times more for Americans than it does in other countries. So, we don’t need drug… Read More

Chronic conditions, such as diabetes, require management, care, and medications. When insurers create hurdles that directly or indirectly block access to care, those patients suffer. And apparently, that’s exactly what’s happening across… Read More

In case you’re not up to speed on the drama, managed care organization Centene is no stranger to legal settlements. We call it ‘managed care mischief’ — when a private company is… Read More

We’ve come a long way in modern medicine, especially when it comes to HIV care. In the mid-90s, life expectancy at age 20 for HIV-infected individuals was just 39 years old. Today,… Read More

To get a job done right, it’s often better to take care of it yourself. But that’s not necessarily the case for many states when it comes to health insurance coverage for… Read More

Maybe in 2023, the federal government will employ a fair way to settle billing disputes between hospitals and insurance companies. But with the Texas Medical Association (TMA) filing its third lawsuit this… Read More

What if there was an opportunity to make the biggest health insurance conglomerate in the United States even more powerful by equipping them with boatloads of sensitive health data? Imagine no more.… Read More