How UnitedHealth’s Playbook for Limiting #MentalHealth Coverage Puts Countless Americans’ Treatment at Risk
—

United used an #algorithm system to identify #patients who it determined were getting too much #therapy and then limited coverage. It was deemed illegal in three states, but similar practices persist due to a patchwork of #regulation.

#News #Healthcare #Health #Insurance #UnitedHealth #Medicaid #Government

propub.li/3Ogrfow

Inside UnitedHealth’s Playbook for Limiting Mental Health Coverage

United’s practices were deemed illegal in three states. But that hasn’t stopped the company from policing mental health care with arbitrary thresholds and cost-driven targets.

^ProPublica

#Lincare Made Billions While Repeatedly Defrauding #Medicare. Feds Did Little To Rein It In.
—

Lincare, the nation’s largest distributor of home oxygen equipment, has repeatedly violated Medicare rules and probation agreements, victimizing ailing patients and costing taxpayers huge sums. The federal #government has done little to stop it.

propub.li/3UNDUms

#News #Healthcare #Insurance #Fraud #CPAP #Health

Lincare Made Billions While Repeatedly Defrauding Medicare. Feds Did Little To Rein It In.

Lincare, the nation’s largest distributor of home oxygen equipment, has repeatedly violated Medicare rules and probation agreements, victimizing ailing patients and costing taxpayers huge sums. The federal government has done little to stop it.

^ProPublica

State Regulators Know #Health #Insurance Directories Are Full of Wrong Information. They’re Doing Little to Fix It.
—

Health insurance experts said that, unless agencies can crack down and issue bigger fines, insurers will keep selling error-ridden plans.

propub.li/3UOxzHy

#News #Healthcare #Accountability #Regulation #MentalHealth #NewYork #Arizona #Massachusetts #California

Why Health Insurance Regulators Have Failed to Curb Ghost Networks

State agencies say they’re holding insurers accountable for errors in provider directories. But ProPublica found that the actual actions taken so far do not match the regulators’ rhetoric.

^ProPublica

Our "Uncovered" series has more on how the #insurance industry denies coverage to #patients.

One of the stories describes how Cigna #doctors reject patients' claims without opening their files. "We literally click and submit," one former company doctor said. 👇

#News #Healthcare #Health

propub.li/4dXhXs3

How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,” one former company doctor said.

^ProPublica

👉 Remember: You have a right to find out why your health insurer denied your claim. We built a tool to help you: propub.li/3Uj4ZO8

#Health #Insurance #Healthcare #Journalism #News

Find Out Why Health Insurance Denied Your Claim

You likely have the right to access records that explain why your insurer denied your claim or prior authorization request. Use ProPublica’s free tool to generate a letter requesting your claim file from your health insurance company.

^ProPublica

“Not Medically Necessary”: Inside the Company Helping America’s Biggest #Health Insurers Deny Coverage for Care
—

When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to #EviCore, whose business model depends on turning down payments for #care recommended by #doctors for their #patients.

propublica.org/article/evicore…

#News #Insurance #Algorithm #AI #Healthcare

EviCore, the Company Helping U.S. Health Insurers Deny Coverage for Treatments

When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to EviCore, whose business model depends on turning down payments for care recommended by doctors for their patients.

^ProPublica