prior authorization
Coverage of prior authorization in the Nexus archive.
- She Struggled To Get a Lifesaving Drug Even After Insurers Vowed To Help
Margaret Hvatum, a 70-year-old with primary immunodeficiency, faced insurance denials for her lifesaving drug Hizentra after switching Medicare Advantage plans, leading to health complications and denied hospital charges. The denial stemmed from prior authorization issues, a process that contributed to her hospitalization and financial burden.
- Trouble Getting Weight Loss Drugs Covered by Insurance? Here’s What To Know
Insurance coverage for GLP-1 weight loss drugs like Zepbound and Wegovy is being dropped by many plans due to high costs, leaving patients to seek alternatives. Patients may retain coverage if the drugs are prescribed for related conditions like sleep apnea or diabetes through prior authorization.
- UnitedHealth bets $3B on AI to cut costs and ease industry backlash
UnitedHealth Group is investing $3 billion in artificial intelligence to automate administrative and claims-related tasks, aiming to reduce costs and address public criticism. The initiative targets areas like medical coding and customer service, but faces risks related to AI accuracy and regulatory scrutiny.
- Waiting for prior authorization almost killed me
A patient recounts how prior authorization delays from an insurance company nearly caused their death due to untreated liver disease, highlighting systemic issues in healthcare rationing and bureaucratic hurdles. The author criticizes insurance companies for prioritizing profits over patient care and calls for reform in a system that forces physicians and patients to fight for necessary treatments.
- UnitedHealthcare removing prior approval for most pediatric services
UnitedHealthcare is removing prior approval requirements for most pediatric services. This decision is part of insurance companies' efforts to address backlash against prior authorization mandates.
- UnitedHealthcare removing prior approval for most pediatric services
UnitedHealthcare is removing two-thirds of prior authorization requirements for members under age 18 by the end of the year, citing physicians' concerns about unnecessary barriers to timely care. The insurance company is scaling back a process criticized as adding delays to pediatric medical services.
- UnitedHealthcare to eliminate prior authorization for 30 percent of services
UnitedHealthcare plans to eliminate prior authorization requirements for 30% of services by the end of 2026, simplifying the process for patients and healthcare providers. This change aims to improve access to care and reduce administrative burdens. The move is part of the company's efforts to streamline its services.