Tag: Insurance

Private payers profit by delaying medical claims

Editor's Note Private payers initially deny reimbursement on 15% of claims, only to later approve more than half of those initial denials, according to a national survey of healthcare institutions published March 21 by Premiere, Inc. Additionally, the denied claims on average tend to be more prevalent for higher-cost treatments…

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By: Matt Danford
April 4, 2024
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How data puts the ‘value’ in value-based care

What if a surgeon decided to perform a procedure on a patient that was not totally necessary? It happens more often that one might realize. As recently as August 2023, Forbes published an article that cited a Harvard Business Review report stating that over 50% of lumbar spine surgeries are…

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By: David Cotriss
March 22, 2024
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Alabama immunity legislation shields IVF patients, providers

Editor's Note A new Alabama law provides civil and criminal immunity for providers and patients of in vitro fertilization (IVF) services, the Associated Press reported March 7. Last month, the Alabama Supreme Court effectively ruled that frozen embryos are people with a constitutional right to life, casting doubt on the…

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By: Matt Danford
March 7, 2024
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Hospital hacking threats persist amid continued chaos of Change Healthcare cyberattack

Editor's Note The ransomware group behind a recent cyberattack on one of the nation’s largest health systems has its sights set on hospitals, the FBI and the Department of Health and Human Services (HHS) warned February 27. According to a report in Chief Healthcare Executive one day later, systems were…

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By: Matt Danford
March 1, 2024
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Coordinating surgical care means precise staff handoffs

In every OR, the complicated dance of surgical care coordination—the series of handoffs between stakeholders throughout the surgery lifecycle—is performed mainly in the background. Those stakeholders include physician offices, schedulers, preadmission testing, insurance verification, vendors, sterile processing, supply chain, anesthesia, and surgical staff. But what does it look like when…

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By: Carisa Brewster and Jonathan Reimer
January 23, 2024
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Doctors with multiple malpractice suits become insurance company medical directors

Editor’s Note An investigation by the nonprofit organization ProPublica and the Capital Forum revealed many doctors with a history of malpractice cases now serve as insurance company medical directors—a role with major influence on decisions that impact patient outcomes. According to a December 15 article in ProPublica, the organizations used…

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By: Brita Belli
December 15, 2023
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A closer look at variations in regional health insurance prices

Editor's Note This new study in JAMA Health Forum is one of the first to review publicly available insurer price data and compare regional rate differences. The research was published by JAMA Network on October 27. Following are some highlights: Over half of the US population receives health insurance from…

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By: Brita Belli
October 30, 2023
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Problems with prior authorization, utilizing health insurance coverage are prevalent, survey finds

Editor's Note This KFF survey from June 2023 found that some six in 10 adults with health insurance have experienced problems when trying to use their insurance, KFF Health News September 29 reports. The problems included denied claims, network adequacy issues, and preauthorization delays and denials.  According to the survey,…

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By: Brita Belli
October 4, 2023
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US uninsured rate reaches all-time low

Editor's Note  The number of Americans without health insurance coverage has hit a record low of 8% this year, exceeding the previous low of 9% in 2016, the Department of Health and Human Services July 3 reports. Since 2020, 5.2 million people have gained coverage, including 4 million adults and…

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By: Lauren McCaffrey
August 4, 2022
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Lawsuit filed against UnitedHealth for underpayment of telehealth services

Editor's Note A female patient in Chicago, Illinois, filed a lawsuit on July 7 against the multinational UnitedHealth Group for alleged underpayment of telehealth services, Becker’s Payer Issues July 8 reports. The lawsuit claims that the woman’s insurance plan covers telehealth services, including pay benefits for-out-network services. After receiving out-of-network…

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By: Lauren McCaffrey
July 12, 2022
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