‘You’ll never get that information’: Inside the brutal PBM exam process
PBM examiners describe a hostile response and a pattern of delays, obfuscations and persistent legal threats.
The latest news, regulation and trends in health and employee benefits.
PBM examiners describe a hostile response and a pattern of delays, obfuscations and persistent legal threats.
Interim President and Chief Executive Officer Jerome T. Upton is leading the company during CEO Tom McInerney’s medical leave.
Why it’s crucial for advisors to address the realities of planning for and paying for care.
The following information was released by the Henry J. Kaiser Family Foundation:. Authors: Michelle Long, Jeannie Fuglesten Biniek, Justin Lo, Rayna Wallace, Jada Raphael, Allison Kim, and Kaye Pestaina. In 2024, the Centers for Medicare and Medicaid Services published a final rule aimed at streamlining and automating the prior authorization process for almost…
Conducted in June for the Georgia Health Initiative, the survey found that more than 90% of Democrats and Republicans who responded had health insurance coverage. Yet concerns about rising costs crossed party lines, with 54% of Democrats and 38% of Republicans saying they were very or somewhat worried about being able to afford their monthly premiums over…
Luigi Mangione, the man accused of shooting and killing a health insurance executive on a Manhattan sidewalk, is expected to plead guilty in a federal case charging him with stalking, the New York Times reported Thursday, citing two people with knowledge of the matter. A guilty plea, which is not guaranteed, would avert a trial in the closely watched case over the…
The following information was released by the New York State Department of Financial Services:. New York State Department of Financial Services Acting Superintendent Kaitlin Asrow today issued new guidance to health insurers, health care providers, and independent dispute resolution entities implementing improvements to the IDR process signed into…
NEW YORK- Luigi Mangione is expected to plead guilty Friday in federal court in Manhattan, where he faces charges of stalking resulting in the death of a health insurance executive in 2024, according to two people with knowledge of the matter. When asked at an unrelated news conference Wednesday about a potential plea, Jamie McDonald, the top federal prosecutor…
Maura Healey stopped in Haverhill on Tuesday morning to announce a new statewide effort to help Medicaid recipients who could be at risk of losing their healthcare coverage simply because they missed a letter, deadline or new requirement. Andy Vargas and Ryan Hamilton, Health Care For All Executive Director Jennifer Lemmerman, Community Action Inc. CEO…
Funders for this research include US Department of Veterans Affairs, Duke University, US Department of Veterans Affairs, Durham Center of Innovation to Accelerate Discover and Practice Transformation at the Durham Veterans Affairs Health Care System. The news reporters obtained a quote from the research from Duke University,“ We describe variation in the…
2026 AUG 13– By a News Reporter-Staff News Editor at Insurance Daily News– Investigators publish new report on Managed Care. We evaluated outcomes of a dental clinic co-located within a health center in Jefferson County, a rural Health Professional Shortage Area in Washington state.”. Our news journalists obtained a quote from the research from the University…
2026 AUG 13– By a News Reporter-Staff News Editor at Insurance Daily News– Data detailed on Managed Care have been presented. The news correspondents obtained a quote from the research from the University of Michigan,“ Hospitals were categorized into terciles of 180- day postoperative inpatient infection rates. Among 239,039 procedures at 1,007 hospitals,…
2026 AUG 13– By a News Reporter-Staff News Editor at Health Policy and Law Daily– Current study results on Clinical Trial Research have been published. According to news originating from Hannover, Germany, by NewsRx correspondents, research stated,“ This study sought to evaluate the characteristics of clinical-pharmacological medication reviews conducted…
Financial support for this research came from National Center for Special Education Research, Institute of Education Sciences. For more information on this research see: Integrating Data To Examine Policy and Complex Equity Issues: an Illustrative Case In Special Education. Journal of Disability Policy Studies, 2026. Journal of Disability Policy Studies…
Conducted in June for the Georgia Health Initiative, the survey found that more than 90% of Democrats and Republicans who responded had health insurance coverage. Yet concerns about rising costs crossed party lines, with 54% of Democrats and 38% of Republicans saying they were very or somewhat worried about being able to afford their monthly premiums over…
Conducted in June for the Georgia Health Initiative, the survey found that more than 90% of Democrats and Republicans who responded had health insurance coverage. Yet concerns about rising costs crossed party lines, with 54% of Democrats and 38% of Republicans saying they were very or somewhat worried about being able to afford their monthly premiums over…
Like 155 million other Americans, I get my health insurance coverage through my employer. The millions like me who are not on Medicaid or Medicare may not be closely tracking massive changes coming to public insurance programs because of H.R.1. In California, the uninsured rate dropped from 18% before the ACA to below 6% in 2024.
"Vermonters are already facing significant barriers to afford and access the health care they need, and the Trump Administration's proposed rule will only make these challenges worse," said Attorney General Clark. Congress enacted the ACA to expand access to affordable health insurance, and more than 23 million Americans currently receive coverage through…
The Trump administration is finalizing a rule restricting Medicaid and the Children's Health Insurance Program from covering gender-affirming care for trans youth, according to a document set to be published by the Department of Health and Human Services. The White House first proposed the rule last December under HHS Secretary Robert F. Kennedy, Jr, who…
If you ask New Jersey state Sen. Jon Bramnick which industry exerts the most influence in Trenton, the answer is a no-brainer: health insurers. With the new law, New Jersey joined roughly half the country in restricting use of accumulators, an issue that doesn’ t dominate headlines but is a major fault line in the battle between drugmakers, which say insurers are…
BOISE— A group of legislators on Tuesday assembled at the Idaho Capitol for the first meeting of the Idaho Health Insurers Working Group, created this year to examine a range of issues including rates of claim denial, medical provider reimbursement rates and treatment delays stemming from prior authorization. Though the task force’ s emphasis is…
Willie Nathan Young Sr., 38, is charged with scheme to defraud involving between $20,000 and $50,000, a second-degree felony. If convicted, Young faces up to 15 years in prison and a $10,000 fine under Florida law. Investigators allege Young failed to disclose that he was actively running his business, Blessed Movers LLC, while collecting benefits, despite the…
PBM examiners describe a hostile response and a pattern of delays, obfuscations and persistent legal threats.