Talking about what others are afraid to say
You might think not-for-profit health insurers have a lower claim denial rate, but 2024 research shows that’s not true. I pulled the latest CMS Transparency in Coverage data available for the …
How Nonprofit Insurers Compare in Claim Denials Read More
A recent LinkedIn post by entrepreneur Mark Cuban argues that the answer is yes—Americans absolutely can shop for health insurance. But he also points out a more complicated reality: having choices …
Health Insurance Choice Isn’t the Problem—The Marketplace Is Read More
Are insurance companies using artificial intelligence to override physicians’ medical judgments and deny necessary care to vulnerable patients? The answer is nuanced. There is evidence that some Medicare Advantage insurers …
The Controversy of AI in Health Coverage Decisions Read More
Imagine sitting across from your doctor after weeks of tests, consultations, and uncertainty. Your physician finally has an answer and recommends a treatment plan tailored to your condition. You feel …
The Impact of Insurance Decisions on Patient Care Read More
The oncology pipeline has never been more promising. Every year, pharma companies announce breakthrough therapies, precision medicines, antibody-drug conjugates, cell therapies, and immunotherapies that offer hope to patients facing some …
In the End, Insurers Will Decide Which New Oncology Drugs Are Approved Despite the Data Read More
(ACA) have officially expired. Prior to their expiration, this policy delivered notable public benefits: millions of Americans saw their monthly health insurance premiums reduced, national health insurance enrollment rose significantly, …
The Hidden Dangers of Low-Cost Health Insurance Plans Read More
If you get health insurance through your job, you probably know that your employer foots a big chunk of the bill. What you might not realize is that for many …
Do Employers Have Access To Employee Medications? Read More
Pharma still models success as a linear funnel: diagnosis → prescription → fulfillment. However, this simplified model fails to account for the complexities of real-world scenarios. The moment a payer …
When Coverage Fails, So Does the “Script = Fill” Assumption Read More