authorization Archives - DR News - News, Retirement, Finance

Authorization Fight: States Battle Insurers for Patient Care

Tucson, Arizona – Amina Tollin, a 40-year-old woman, has been grappling with a chronic nerve condition called polyneuropathy for years, causing her debilitating pain that required her to use a wheelchair. With a monthly cost of $18,000 for each session of blood infusion therapy prescribed by her doctor, Tollin found relief until Medicaid ceased coverage, halting her treatments. This interruption was a result of a common practice called prior authorization, where insurers require approval before …

What you need to know before choosing a Medicare Advantage Plan

Medicare Advantage plans are attracting an increasing number of seniors who are seeking a wider range of healthcare coverage options. Offered by private insurers, these plans include benefits beyond what original Medicare provides, such as dental cleanings, eye exams, and wellness perks like fitness club memberships. Medicare Advantage plans, however, come with challenges and limitations. According to data from Axios, over half of eligible beneficiaries – 51% – are currently enrolled in Medicare Advantage plans. …

Lawmaker Advocates for Medicare Advantage Reforms and Prior Authorization Changes

Rep. Larry Bucshon, MD (R-Indiana) acknowledges the widespread problem of prior authorizations in the medical community and the need for reform. The U.S. Department of Health and Human Services’ Office of Inspector General also recognizes this issue. This acknowledgment comes as Medicare Advantage reforms are being considered. The burdensome process of prior authorizations has been a long-standing issue for healthcare providers, patients, and insurers. It often leads to delays in patient care, administrative burdens for …

Insurance Companies to Speed Up Prior Authorization Process Under Biden Administration’s Finalized Rule

WASHINGTON, D.C. – The Biden administration has announced new regulations aimed at curbing the practice of prior authorization by private health insurance companies. Prior authorization often leads to delayed care and opaque appeals processes for patients seeking medication or surgery. Under the newly finalized rules, insurance companies working with federal programs will be required to expedite the approval process for urgent requests and make decisions within 72 hours. Additionally, these companies must provide a specific …

Authorization Woes: Medical Hurdles Blocking Patient Care

Asheville, North Carolina – A growing number of patients are facing hurdles known as “prior authorization” when seeking medical care. This process, common in the United States, requires doctors to obtain approval from insurance companies before certain treatments, tests, or medications can be provided. While initially intended to control costs and ensure appropriate care, many patients and healthcare providers are finding that prior authorization can lead to delays, denials, and frustration. In recent years, the …

Prior Authorization Policy Challenges Addressed in AHA Panel Discussion on Care Delays and Physician Burnout

Chicago, Illinois – Healthcare professionals gathered at the AHA Annual Membership Meeting to discuss the challenges posed by prior authorization policies. The panel, moderated by Marilyn Werber Serafini of the Bipartisan Policy Center, delved into the impacts of commercial insurance practices on patient care and healthcare systems. During the panel discussion, Dr. Shikha Jain of UI Health highlighted the significant delays and administrative burdens caused by prior authorization requirements. She emphasized the detrimental effects on …

Authorization Legislation Affects Patients’ Access to Vital Medical Treatments

Tucson, Arizona – Amina Tollin, a resident of Tucson, Arizona, faced years of debilitating pain that stemmed from polyneuropathy, a chronic nerve condition. The condition had rendered Tollin reliant on a wheelchair until she began undergoing a blood infusion therapy, prescribed by her doctor, which enabled her to lead a normal life. However, Tollin’s life took a turn for the worse about three months ago when Medicaid abruptly ceased coverage for her therapy, citing the …