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Claim Denials and Prior Authorization
Claim Denials and Prior Authorization in Health Insurance: the news, the names and what changed.
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Nearly Three-Quarters of Medicare Advantage Enrollees Could be Denied a Medigap Policy Due to a Pre-Existing Condition
2+ day, 4+ hour ago (300+ words) Nearly Three-Quarters (74%) of Medicare Advantage Enrollees Could Be Denied a Medigap Policy Due to a Pre-Existing Condition in 2023 Excludes Puerto Rico and other territories. Analysis based on ICD-10 codes of deniable conditions from Medigap applications. Pre-Existing Conditions Among Medicare Advantage Enrollees…...
Insurance Red Tape Keeps Blistering Disease Patients From Lifesaving Biologics
3+ day, 4+ hour ago (569+ words) A new survey of United States patients with autoimmune blistering diseases documents how insurance requirements such as prior authorization and step therapy delay access to biologic therapies that clinical trials show work best when started early....
Diagnostic Lab Claim Denials Rose 40% in 2025, Report Finds
1+ week, 3+ hour ago (301+ words) Oct 8, 2026 | Lab Management | Denials of clinical laboratory, molecular diagnostic, and genomics claims increased to 11.2% in 2025 from 8.0% in 2024, according to the 2026 Payor Denial Impact Report released by revenue cycle management provider XiFin. The 40% year-over-year jump erased two years of improvement across…...
Patient-Reported Denials, Appeals, and Complaints: Associations With Overall Plan Ratings
1+ week, 11+ hour ago (1127+ words) Patient ratings of plans and care were lower among beneficiaries filing complaints or reporting denied care. Appeals did not further predict ratings, but successful complaint resolution did. Objectives: To assess whether Medicare patients’ reports of denied care, appeals/complaints, and satisfactory…...
Analysis Reveals High Cost of Discontinued HMA Treatment for MDS
1+ week, 11+ hour ago (483+ words) HMAs are recommended therapeutic options for patients with HR-MDS because they have been associated with survival benefit, improved quality of life, and improvement in cytopenias, which leads to delayed progression to acute myeloid leukemia. “In order to elicit clinical response,…...
Her Doctor Used to File Four Prior Authorizations for One Cancer Case. Aetna Medicaid Is Folding Them Together in 8 States
1+ week, 2+ day ago (992+ words) A lymphoma patient on Medicaid can face four separate insurance permission slips before her first treatment begins, and every one of those gates is a chance for her care to stall. Aetna is rethinking that process in eight states, but…...
Senators Probe Insurers Over No-Payout Claims
1+ week, 2+ day ago (1205+ words) Briefs Finance Warren and Hawley press six insurers on surge in claims closed with no payout - US Senators Elizabeth Warren and Josh Hawley asked six major insurers for data on claims that are closed without paying policyholders. - They want counts…...
Your Doctor Takes Medicare — That Doesn’t Automatically Mean Every Medicare Advantage Plan
1+ week, 4+ day ago (173+ words) SavingAdvice.com is a trusted personal finance news and community with expert stories on saving money, budgeting, debt reduction, and investing — plus active forums and tools to guide your financial journey. Have you ever discovered that a doctor accepted Medicare…...
Divergent Cost Trends for 3 Advanced Cancers, 2013 vs 2022: A Commercial Claims Analysis
1+ week, 4+ day ago (699+ words) A comparison of 2013 and 2022 data shows that cancer costs are not uniformly rising. Costs decreased for metastatic colorectal cancer but increased for both metastatic non–small cell lung cancer and multiple myeloma. Methods: Using MarketScan Commercial Claims and Encounters data,…...
Oral Targeted Anticancer Medication Use Following High-Deductible Health Plan Enrollment
1+ week, 4+ day ago (390+ words) The American Journal of Managed Care Employer-mandated enrollment in a high-deductible health plan did not reduce use of oral targeted anticancer medications among patients commercially insured between 2007 and 2021. Am J Manag Care. 2026;32(10):545-547 The study included 124 members with an employer-mandated switch…...