Checkpoints exist throughout the American health care system. They ensure people receive appropriate care and avoid preventable errors in treatment or diagnoses. While doctors and hospitals manage ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. This voice experience is generated by AI. Learn more. This voice ...

Physician groups are urging the Trump administration to give them more information on insurance companies’ pledges to change ...

This article highlights challenges in prior authorization and offers practical, experience-based strategies to streamline workflows, reduce delays, and improve patient access to necessary treatments.

Prior authorization is a process that involves contacting a person’s Medicare provider to request coverage for a medical service, drug, or piece of equipment. If a person has Original Medicare (parts ...

UnitedHealthcare, CVS Health and Humana had the highest denial rates for long-term care requests, according to a report from the agency’s inspector general.

Prior authorization requirements for PCSK9 inhibitor prescriptions are more cumbersome than those in place for other cardiometabolic drugs, a new study demonstrates. The complex processes are seen for ...

Medical groups are optimistic that a recently reintroduced bill to rein in prior authorization has a better chance of passage now than it did last time around. "We believe the bill is poised for ...