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BPAS
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Regional Vice President, Sales MAP Retirement USA LLC
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Retirement Relationship Manager MAP Retirement
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ESOP Administration Consultant Blue Ridge Associates
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BPAS
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Relationship Manager for Defined Benefit/Cash Balance Plans Daybright Financial
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Anchor 3(16) Fiduciary Solutions
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July Business Services
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-- An attorney subscriber
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Search the News Archive
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18 Matching News Items |
| 1. |
ProPublica
Aug. 18, 2025
"[F]ederal employees, policy experts and front-line workers warn that suspending the rules and cutting enforcement funding ... could mean longer waits for help when patients challenge insurance decisions, fewer investigations of insurers and employer health plans over possible violations of federal mental health protections, and more people going without care they're legally entitled to."
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| 2. |
ProPublica
May 9, 2025
"In the U.S., drug companies determine what to charge for their products with few restraints.... One possible solution to bring down costs: tie American prices to what drugmakers charge in other wealthy countries. The Congressional Budget Office found last year that this would have the biggest impact on reducing costs of seven proposals it studied. It's an idea with bipartisan support."
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| 3. |
ProPublica
Apr. 13, 2025
"Blue Cross Louisiana [approved] mastectomies and breast reconstructions for women with cancer but refused to pay a hospital's full bills.... Blue Cross denied payments for thousands of procedures involved in breast reconstruction. But it approved special deals for treatment for executives' wives.... A jury found Blue Cross liable for fraud and awarded the hospital $421 million. The insurance company denied wrongdoing and has appealed."
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| 4. |
ProPublica
Feb. 12, 2025
"The story of Zolgensma lays bare a confounding reality about modern drug development, in which revolutionary new treatments are becoming available only to be priced out of reach for many. It's a story that upends commonly held conceptions that high drug prices reflect huge industry investments in innovation. Most of all, it's a story that prompts, again and again, an increasingly urgent question: Do medical advances really have to be this expensive?"
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| 5. |
ProPublica
Jan. 24, 2025
"Health plans, and the companies that administer them, have excluded key behavioral treatments, such as therapies for substance use and autism, and offered inadequate networks of mental health providers, according to a 142-page report released Jan. 17 ... The report, which the agencies are required to file regularly to Congress, also detailed the results of secret shopper surveys of more than 4,300 mental health providers listed in insurance directories and found an 'alarming proportion' were 'unresponsive or unreachable.' "
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| 6. |
ProPublica
Dec. 31, 2024
"Health insurers frequently review patients' progress to see if they can be moved down to a lower -- and almost always cheaper -- level of care. That can cut both ways. They sometimes cite a lack of progress as a reason to deny coverage, labeling patients' conditions as chronic and asserting that they have reached their baseline level of functioning. And if they make progress, which would normally be celebrated, insurers have used that against patients to argue they no longer need the care being provided."
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| 7. |
ProPublica
Dec. 30, 2024
"Many Americans have faced the denial of mental health treatment by their insurance companies -- at times despite vivid evidence of the risk such decisions pose. In most cases, patients don't appeal. But in a tiny percentage, patients and their families decide to fight the denials in federal court, setting up a David-versus-Goliath battle where insurers frequently have the upper hand."
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| 8. |
ProPublica
Nov. 19, 2024
"Three states found United's algorithmic system to limit mental health coverage illegal; when they fought it, the insurer agreed to restrict it.... The company is policing mental health care with arbitrary thresholds and cost-driven targets, highlighting a key flaw in the U.S. regulatory structure.... The poorest and most vulnerable patients are now most at risk of losing mental health care coverage as United targets them for cost savings."
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| 9. |
ProPublica
Nov. 14, 2024
"Many states have sought to make insurers clean up their health plans' provider directories over the past decade. But the errors are still widespread.... Most state insurance agencies haven't issued a fine for provider directory errors since 2019. When companies have been penalized, the fines have been small and sporadic.... Experts said that stricter regulations and stronger fines are needed to protect insurance customers from these errors, which are at the heart of so-called ghost networks."
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| 10. |
ProPublica
Oct. 23, 2024
"America's largest insurers hire EviCore to make decisions on whether to pay for care for more than 100 million people.... EviCore uses an algorithm that allows it to adjust the chances that company doctors will screen prior authorization requests, increasing the possibility of denials.... Some EviCore contracts are based on how deeply the company can reduce spending on medical procedures. It tells insurers that it can provide a 3-to-1 return on investment."
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