Editor’s Note An investigation by the nonprofit organization ProPublica and the Capital Forum revealed many doctors with a history of malpractice cases now serve as insurance company medical directors—a role with major influence on decisions that impact patient outcomes. According to a December 15 article in ProPublica, the organizations used…

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Editor's Note This new study in JAMA Health Forum is one of the first to review publicly available insurer price data and compare regional rate differences. The research was published by JAMA Network on October 27. Following are some highlights: Over half of the US population receives health insurance from…

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Editor's Note This KFF survey from June 2023 found that some six in 10 adults with health insurance have experienced problems when trying to use their insurance, KFF Health News September 29 reports. The problems included denied claims, network adequacy issues, and preauthorization delays and denials.  According to the survey,…

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Editor's Note  The number of Americans without health insurance coverage has hit a record low of 8% this year, exceeding the previous low of 9% in 2016, the Department of Health and Human Services July 3 reports. Since 2020, 5.2 million people have gained coverage, including 4 million adults and…

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Editor's Note A female patient in Chicago, Illinois, filed a lawsuit on July 7 against the multinational UnitedHealth Group for alleged underpayment of telehealth services, Becker’s Payer Issues July 8 reports. The lawsuit claims that the woman’s insurance plan covers telehealth services, including pay benefits for-out-network services. After receiving out-of-network…

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Editor's Note According to the February 16 Becker’s Hospital Review, Health and Human Services (HHS) Secretary Xiaver Becerra said the Biden administration is estimating it will need some $30 billion to continue to fight against COVID-19. Another HHS representative told Politico the funding is needed "for additional resources to support…

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Editor's Note According to the February 2 Becker’s ASC Review, two ambulatory surgery centers (ASCs) recently filed lawsuits against insurance payers over reimbursement, or lack thereof, for spinal procedures. Surgery Center of Viera, based in Melbourne, Florida, filed its lawsuit January 20 against Cigna and consulting services Strategic Enterprise Solutions…

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Editor's Note This study by researchers from New York University School of Medicine finds several factors associated with increased odds of readmission of patients hospitalized with COVID-19. In this retrospective cohort analysis of 6,191 adult patients hospitalized with COVID-19 in a New York safety-net hospital system between March 1 and…

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Editor's Note This study from Brigham and Women’s Hospital and Harvard Medical School, Boston, finds that Black patients used telemedicine platforms more often than White patients for ambulatory surgical care during Phase 2 of COVID-19. During Phase 1 (March 24 through June 23), there were 347 in-person and 638 virtual…

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Editor's Note This study, led by researchers at UCLA David Geffen School of Medicine, finds that the use of ambulatory care services between March 2020 and February 2021 increased after an initial decrease with the onset of COVID-19. However, the rate of increase was significantly lower for Medicaid and/or Medicare…

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