Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.
The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.
But I thought if we had universal healthcare there would be death panels deciding whether gradma got her medicine! Now you’re telling me its the private insurers that do that?
Now you’re telling me its the private insurers that do that?
Always has been.
I was being ironic
Hence the meme response.
Going through this right now. Had to change insurance because of new job, this new insurance is fighting tooth and nail to not pay for the medicine I’ve been taking for years that keeps my Crohn’s under control. I’ve been without it for over a hundred days, and things are starting to backslide.
Literally, I’m getting sicker as they waste my time. They’re shit genuinely sickening.
For what it’s worth, contact your employer’s benefits coordinator. They can often slap the insurance company around since they’re the people essentially paying the bill.
Time for my link:
Frame Canada
Wendell Potter spent decades scaring Americans. About Canada. He worked for the health insurance industry, and he knew that if Americans understood Canadian-style health care, they might… like it. So he helped deploy an industry playbook for protecting the health insurance agency.
Thanks for that link!🏆
i love how we constantly jerk off about how we’re the best and richest and freeest country in the world but we do this to our citizens
Health Net does this BS all the time. Even care that has been previously approved and paid for is regularly denied if needed again because “It’s not a covered service.” It would literally take hours on the phone to convince Health Net’s customer service that they needed to pay a claim, and even then there was no guarantee that they would actually pay it. Three 60 minute calls to get a bill paid were not unusual.
One time Health Net refused to pay for care they had previously approved in writing. Monthly calls were ignored for 8 months until the medical center sent the bill to collections.
Increasing profits because your company refuses to pay for contracted & covered care should be illegal.
In what universe is 72 hours considered an acceptable response time for anything considered “urgent”?
US healthcare is extortion.
Federalize the health insurance industry.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests.
All I’m seeing is suddenly every request will not be urgent. Your heart transplant isn’t that urgent, see your not dead yet.
The answer to the whole mess is single payer. Where the hell is Biden on that?
