NEW YORK, NY: In the Turtle Bay neighborhood of Midtown Manhattan, UnitedHealth executives woke this week to the horrifying news that federal funding for Medicare Advantage would remain flat, which … Read more
INDIANAPOLIS, IN – BlueChoice Health announced this week that it is launching Same-Day Denials™, a breakthrough program designed to improve the member experience by delivering fast, clear answers to coverage … Read more
A mindless denial An insurance executive confirmed this week that a lifesaving treatment was canceled after a routine utilization review revealed the patient had not completed a required trial of … Read more
Long before America learned to fear laminated menus and curt hand gestures, the man later known as the Soup Nazi was already honing his craft in a far more unforgiving … Read more
Effective Date: ImmediatelyApplies To: Utilization Management, Prior Authorization, and All Parties Capable of Remembering Things 1. Purpose The Requester Integrity Standard (RIS-01) establishes uniform requirements for obtaining documentation during the … Read more
A Crisis Hidden in Plain Sight Policy reformers often discuss healthcare sanity as if it were an abstract good, something that simply happens once spreadsheets align and incentives behave. What … Read more
CONFIDENTIAL — INTERNAL DISTRIBUTION ONLYDO NOT FORWARD / DO NOT PRINT / DO NOT ACKNOWLEDGE From: Office of Strategic AlignmentTo: Public Relations, Government Affairs, Messaging, & Narrative IntegrityRe: Sustaining the … Read more
WASHINGTON—Several major insurance companies announced voluntary price reductions Friday after learning that President Trump intended to ask them “nicely” to lower costs during a meeting scheduled for later this month. … Read more
Insurers announced a new tool. They say it improves transparency, efficiency, and margins. They mostly say efficiency. It’s called the Guess-o-meter™. A proprietary system. No outside review. No explanation. The … Read more
WASHINGTON—Health insurers confirmed this week that prescription formularies are built using a disciplined, data-driven method known internally as “Who Brought the Biggest Rebate.” Executives described the process as neutral, objective, … Read more