Investigative Journalism in the Public Interest
Leaked internal documents show that the insurance giant is culling providers of applied behavior analysis from its network and scrutinizing the medical necessity of therapy. Advocates say the company’s strategy may be illegal.
The probe found widespread noncompliance and violations of federal law in how health plans and insurers cover mental health care, echoing the findings of a recent ProPublica investigation.
The governor’s ties to the Mayo Clinic raise questions about the world-renowned hospital’s potential influence on federal health care reform.
Federal regulations require insurers to promptly hand over records to patients facing claim denials. Some insurers only turned over their files after ProPublica reached out.
Providers, patients and even some federal judges say progress-based insurance denials harm patients at key moments of mental health treatment.
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.
Doctors working for health insurers can rule on 10,000 or more requests for care a year. At least a dozen were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments.
A federal judge allowed the company to acquire a clearinghouse of health insurance claims. UnitedHealth says it won’t use the data to give itself an edge, even as some company documents suggest otherwise.
States have passed hundreds of laws to protect people from wrongful insurance denials. Yet from emergency services to fertility preservation, insurers still say no.
Outraged by the Jan. 6 Capitol riot, a wilderness survival trainer spent years undercover climbing the ranks of right-wing militias. He didn’t tell police or the FBI. He didn’t tell family or friends. The one person he told was a ProPublica reporter.
A powerful lobbyist convinced a federal agency that doctors can be forced to pay fees on money that health insurers owe them. Big companies rake in profits while doctors are saddled with yet another cost in a burdensome health care system.
After a college student finally found a treatment that worked, the insurance giant decided it wouldn’t pay for the costly drugs. His fight to get coverage exposed the insurer’s hidden procedures for rejecting claims.
Physicians Premier ER charged Dr. Zachary Sussman’s insurance $10,984 for his COVID-19 antibody test even though Sussman worked for the chain and knows the testing materials only cost about $8. Even more surprising: The insurer paid in full.
The thousands of “Trumpcare” ads Facebook and Google have published show that the shadowy “lead generation” economy has a happy home on the platforms — and even big names like UnitedHealthcare take part.
The administration proposed new rules on paying for more veterans to see private doctors, but the lack of details makes the fiscal impact unclear.
Without any public scrutiny, insurers and data brokers are predicting your health costs based on data about things like race, marital status, how much TV you watch, whether you pay your bills on time or even buy plus-size clothing.
With its employee health plan in financial crisis, Montana hired a former insurance insider who pushed back against industry players with vested interests in keeping costs high.
Another lawmaker is asking insurers whether their policies have made it easier for patients to access cheaper, more addictive drugs over less addictive alternatives. Meanwhile, the insurance industry trade group pledged additional steps to combat inappropriate prescribing.
The move follows a story by ProPublica and The New York Times detailing how insurance companies and pharmacy benefit managers have made it easier to get opioid painkillers than less risky alternatives.
The New York Times and ProPublica have teamed up to investigate who is to blame for skyrocketing drug prices — and have turned up some surprising answers.
As insurers ask consumers to pay a greater share of their drug costs, it may be cheaper to pay cash than use your insurance card. One expert estimates that consumers could be overpaying for as many as 1 in 10 prescriptions.
Drug companies and doctors have been accused of fueling the opioid crisis, but some question whether insurers have played a role, too.
The government had planned to share data with researchers on patients enrolled in Medicare Advantage health plans. Then, suddenly, it didn’t.
Federal officials have pointed to overwhelming demand to explain the site's problems. But web developers, other experts and journalists have uncovered more fundamental issues with the design and functioning of the site.
Commentaries published on CNBC.com and the Huffington Post were written by seemingly independent professionals but placed on behalf of the Russian government by its PR firm, Ketchum.
The failure to track doctors who shun cheaper generics racks up huge costs for taxpayers in Medicare Part D, which fills one of every four U.S. prescriptions.
Hospital autopsies have become a rarity. As a result, experts say, diagnostic errors are missed, opportunities to improve medical treatment are lost, and health-care statistics are skewed.
Parents in some states may have fewer choices when shopping for insurance coverage for their children. Many insurers--anticipating rules this week that will bar them from refusing to cover sick children--say they won't issue child-only policies anymore.
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