Inside UnitedHealth’s Effort to Deny Coverage for a Patient’s Care
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.
Sackler Embraced Plan to Conceal OxyContin’s Strength From Doctors, Sealed Testimony Shows
As OxyContin addiction spurred a national nightmare, a member of the family that has reaped billions of dollars from the painkiller boasted that sales exceeded his “fondest dreams,” according to a secret court document obtained by ProPublica.
The Child Abuse Contrarian
Michael Holick, a renowned scientist turned expert witness, relies on his own controversial theory to help alleged abusers avoid prison and regain custody of the babies they were accused of harming.
St. Jude Hoards Billions While Many of Its Families Drain Their Savings
St. Jude Children’s Research Hospital promises not to bill families. But the cost of having a child at the hospital for cancer care leaves some families so strapped for money that parents share tips on spending nights in the parking lot.
Why Do Americans Pay More for Prescription Drugs?
Drug companies in the U.S. face few restraints on what to charge for their products. A bipartisan bill would penalize those companies that sell their drugs at higher prices than the average of the prices in other wealthy nations.
The Price of Remission
When I was diagnosed with cancer, I set out to understand why a single pill of Revlimid cost the same as a new iPhone. I’ve covered high drug prices as a reporter for years. What I discovered shocked even me.
“Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care
When companies like Aetna or UnitedHealthcare want to rein in costs, they turn to EviCore, whose business model depends on turning down payments for care recommended by doctors for their patients.
A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her.
Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast than being right.
Doctors With Histories of Big Malpractice Settlements Work for Insurers, Deciding If They’ll Pay for Care
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.
Congressional Committee, Regulators Question Cigna System That Lets Its Doctors Deny Claims Without Reading Patient Files
The probes follow an investigation by ProPublica and The Capitol Forum that Cigna allows its doctors to reject hundreds of thousands of claims a month.
Health Insurance Claim Denied? See What Insurers Said Behind the Scenes
Learn how to request your health insurance claim file, which can include details about what your insurer is saying about you and your case.
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,” one former company doctor said.
Do You Have Insights Into Dental and Health Insurance Denials? Help Us Report on the System.
Insurers deny tens of millions of claims every year. ProPublica is investigating why claims are denied, what the consequences are for patients and how the appeal process really works.
St. Jude Stashed Away $886 Million in Unspent Revenue Last Year
New documents show that St. Jude Children’s Research Hospital’s reserves grew to $7.6 billion, as other children's cancer nonprofits struggled to raise cash.