A bill intent on reforming the pre-authorization process in Delaware passed both chambers and is now under consideration from Gov. Meyer.

Inappropriate denials for prior authorization and coverage of medically necessary services are a pervasive problem among certain plans in the Medicare Advantage (MA) program.

With a baby on the way, Nathan Kirkland was facing a rare, aggressive form of bile duct cancer. Kirkland’s bills piled up as ...

Stephanie Nixdorf's insurance company declined to cover a drug to treat her arthritis. That changed after she sent an appeal ...

AI for prior authorization determinations in a recent survey. A Senate investigation shows they’re right to worry.

Sundar Subramanian, a partner at PricewaterhouseCoopers (PwC) consulting affiliate Strategy&, has joined population health management company Zyter|TruCare as its newest CEO, Fierce Healthcare | AI ...

If you’re looking for further letter-writing guidance, the Patient Advocate Foundation’s Sample Appeal Letter for Denied Claim and Sample Appeal Letter for Pre-Authorization Denial may help.

In California, consumers and state regulators remain largely in the dark about how often insurers are denying coverage. New ...

CMS issued the 2026 Medicare Physician Fee Schedule, or PFS, proposed rule on July 14.It includes a 0.75% increase to the ...

Offering a rare glimpse inside the hidden world of rejected insurance claims, new data shows a steady uptick among major ...

EPA officials say President Donald Trump’s massive policy law is a death blow to the Greenhouse Gas Reduction Fund. But the ...