Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem

A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.

The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.

The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.

  • ChemicalPilgrim@lemmy.world
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    1 year ago

    But I thought if we had universal healthcare there would be death panels deciding whether gradma got her medicine! Now you’re telling me its the private insurers that do that?

  • someguy3@lemmy.world
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    1 year ago

    Time for my link:

    Frame Canada

    Wendell Potter spent decades scaring Americans. About Canada. He worked for the health insurance industry, and he knew that if Americans understood Canadian-style health care, they might… like it. So he helped deploy an industry playbook for protecting the health insurance agency.

    https://www.npr.org/2020/10/19/925354134/frame-canada

  • deweydecibel@lemmy.world
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    1 year ago

    Going through this right now. Had to change insurance because of new job, this new insurance is fighting tooth and nail to not pay for the medicine I’ve been taking for years that keeps my Crohn’s under control. I’ve been without it for over a hundred days, and things are starting to backslide.

    Literally, I’m getting sicker as they waste my time. They’re shit genuinely sickening.

  • _number8_@lemmy.world
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    1 year ago

    i love how we constantly jerk off about how we’re the best and richest and freeest country in the world but we do this to our citizens

  • einlander@lemmy.world
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    1 year ago

    The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests.

    All I’m seeing is suddenly every request will not be urgent. Your heart transplant isn’t that urgent, see your not dead yet.