Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
I might be using this at some point. I've always thought insurance fraud should go both ways. Medical, housing, car, etc. If they deny my claims for non-valid reasons, why should they be treated differently than when I create a false claim? Hold them accountable and people will hate insurance less/
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
It’s also not right for these giant insurance companies to deny legit medical claims! Luigi is not the only one there’s more Luigi’s out here!
But I agree murder is not the answer not sure what the answer is?
Absolutely ! I agree. It’s disgusting. But there’s the other side of it which is the astronomical cost of medical care. Hospitals are not innocent in this asinine process either. But like I said, murdering CEOs isn’t “right” or the answer.
correct, but can you seperate the act from the thinking or conclusion on the topic itself? murder is murder no matter how you slice it. but was he wrong in what he wrote?
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
correct, but can you seperate the act from the thinking or conclusion on the topic itself? murder is murder no matter how you slice it. but was he wrong in what he wrote?
I have a hard time separating the two. Hes a murderer and the glorifying of him disgusts me.
correct, but can you seperate the act from the thinking or conclusion on the topic itself? murder is murder no matter how you slice it. but was he wrong in what he wrote?
I have a hard time separating the two. Hes a murderer and the glorifying of him disgusts me.
I know it’s apples to oranges but but I feel the same way about the glorification of the incoming president people glorify him and we all know he’s an adulterer and a sexual predator! That disgusts me too
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
not exactly true in my case. we have an excellent hsa plan. 4k deductible 6k out of pocket max for in network family plan.
after company picks up 100% medical, offers co-pays on scripts that are tiered.
to wit. total knee replacement in Dec. Deductible met ladt April. 80k billed. 40k paid by company. NO QUESTIONS ASKED. have paid about 12-15 dollars for the pain meds the last 6 weeks. TOTAL.
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Insurers Failed to Comply With Mental Health Coverage Law, Department of Labor Report Finds
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 U.S. Department of
Labor found widespread noncompliance and violations of federal law in
how health plans and insurers cover mental health care, findings that
mirror a recent ProPublica investigation.
Health plans, and the
companies that administer them, have excluded key behavioral treatments,
such as therapies for substance use and autism, and offered inadequate
networks of mental health providers, according to a 142-page report released Jan. 17 in conjunction with the Treasury and Health and Human Services departments.
The report, which the
agencies are required to file regularly to Congress, also detailed the
results of secret shopper surveys of more than 4,300 mental health
providers listed in insurance directories and found an “alarming
proportion” were “unresponsive or unreachable.” Such error-ridden plans,
commonly known as ghost networks, make it harder for patients to get
the treatment they need, ProPublica has previously found.
Since 2021, the Labor
Department has addressed violations in health plans that serve more than
7 million people, according to the report. The agency has worked to
remedy the problems by seeking changes to plan provisions, policies and
procedures, as well as working to ensure wrongly denied claims were
paid.
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care by T. Christian Miller, ProPublica; Patrick Rucker, The Capitol Forum; and David Armstrong, ProPublica Oct. 23, 2024, 1:30 p.m. EDT Change Appearance Republish Co-published with The Capitol Forum Series: Uncovered: How the Insurance Industry Denies Coverage to Patients More in this series
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. Reporting Highlights
Dialing for Dollars: America’s largest insurers hire EviCore to make decisions on whether to pay for care for more than 100 million people. “The Dial”: EviCore uses an algorithm that allows it to adjust the chances that company doctors will screen prior authorization requests, increasing the possibility of denials. Lucrative Deals: Some EviCore contracts are based on how deeply the company can reduce spending on medical procedures. It tells insurers that it can provide a 3-to-1 return on investment.
These highlights were written by the reporters and editors who worked on this story.
Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.
But the insurance companies don’t always make these decisions. Instead, they often outsource medical reviews to a largely hidden industry that makes money by turning down doctors’ requests for payments, known as prior authorizations. Call it the denials for dollars business.
The biggest player is a company called EviCore by Evernorth, which is hired by major American insurance companies and provides coverage to 100 million consumers — about 1 in 3 insured people. It is owned by the insurance giant Cigna.
A ProPublica and Capitol Forum investigation found that EviCore uses an algorithm backed by artificial intelligence, which some insiders call “the dial,” that it can adjust to lead to higher denials. Some contracts ensure the company makes more money the more it cuts health spending. And it issues medical guidelines that doctors have said delay and deny care for patients.
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Billionaires are using a loophole to avoid Medicare taxes. Closing it — and eliminating other ways around the tax for wealthy business owners — could raise more than $250 billion over 10 years for the program. https://propub.li/4gIto8d
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not just billionaires. Medical groups are doing it as well. They set up "surgery centers" and then none of them put enough time in to be considered "active" so the income flows through as passive. This passive income then allows them to write off a shitload of real estate losses that are passive.
Total bullshit.
Remember the Thomas Nine !! (10/02/2018) The Golden Age is 2 months away. And guess what….. you’re gonna love it! (teskeinc 11.19.24)
1998: Noblesville; 2003: Noblesville; 2009: EV Nashville, Chicago, Chicago 2010: St Louis, Columbus, Noblesville; 2011: EV Chicago, East Troy, East Troy 2013: London ON, Wrigley; 2014: Cincy, St Louis, Moline (NO CODE) 2016: Lexington, Wrigley #1; 2018: Wrigley, Wrigley, Boston, Boston 2020: Oakland, Oakland:2021: EV Ohana, Ohana, Ohana, Ohana 2022: Oakland, Oakland, Nashville, Louisville; 2023: Chicago, Chicago, Noblesville 2024: Noblesville, Wrigley, Wrigley, Ohana, Ohana; 2025: Pitt1, Pitt2
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.
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Insurers sometimes deny coverage citing lack of progress, labeling patients’ conditions as chronic. Yet if they do make progress, insurers have also used that to argue patients no longer need treatment.
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
My wife has been on Humira for about 15+ years, since it was pretty much new. She was forced to go on the generic about 6 months ago, even though it isn't the same. Even before then she'd get periodically denied for no reason, and have to jump through a bunch of hoops to get the medication she was on for years. And has already happened with the generic once since she's been on it. And we've been fighting to get a new med for my son covered for about a month now too. It's just so ridiculous that we can pay 2k a month in premiums just to get denied prescriptions that our doctor is giving us. I've said before, insurance fraud should go both ways. If a company or persons are wrongfully denying coverage to save money, they should be held to the same standard of fraud as someone who is faking an injury to get money.
My wife has been on Humira for about 15+ years, since it was pretty much new. She was forced to go on the generic about 6 months ago, even though it isn't the same. Even before then she'd get periodically denied for no reason, and have to jump through a bunch of hoops to get the medication she was on for years. And has already happened with the generic once since she's been on it. And we've been fighting to get a new med for my son covered for about a month now too. It's just so ridiculous that we can pay 2k a month in premiums just to get denied prescriptions that our doctor is giving us. I've said before, insurance fraud should go both ways. If a company or persons are wrongfully denying coverage to save money, they should be held to the same standard of fraud as someone who is faking an injury to get money.
Sometimes it Makes me think it’s better to not have insurance
My wife has been on Humira for about 15+ years, since it was pretty much new. She was forced to go on the generic about 6 months ago, even though it isn't the same. Even before then she'd get periodically denied for no reason, and have to jump through a bunch of hoops to get the medication she was on for years. And has already happened with the generic once since she's been on it. And we've been fighting to get a new med for my son covered for about a month now too. It's just so ridiculous that we can pay 2k a month in premiums just to get denied prescriptions that our doctor is giving us. I've said before, insurance fraud should go both ways. If a company or persons are wrongfully denying coverage to save money, they should be held to the same standard of fraud as someone who is faking an injury to get money.
Sometimes it Makes me think it’s better to not have insurance
I haven't researched it myself, but there was that news story from a couple weeks ago with that guy in California who paid double using insurance than what the "uninsured discount" was. Really does make no sense in California if you pay thousands a month and still end up paying more for services.
Comments
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
I've always thought insurance fraud should go both ways. Medical, housing, car, etc. If they deny my claims for non-valid reasons, why should they be treated differently than when I create a false claim? Hold them accountable and people will hate insurance less/
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
correct, but can you seperate the act from the thinking or conclusion on the topic itself? murder is murder no matter how you slice it. but was he wrong in what he wrote?
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Insurers Failed to Comply With Mental Health Coverage Law, Department of Labor Report Finds
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.
Series: America’s Mental Barrier: How Insurers Interfere With Mental Health Care
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
The U.S. Department of Labor found widespread noncompliance and violations of federal law in how health plans and insurers cover mental health care, findings that mirror a recent ProPublica investigation.
Health plans, and the companies that administer them, have excluded key behavioral treatments, such as therapies for substance use and autism, and offered inadequate networks of mental health providers, according to a 142-page report released Jan. 17 in conjunction with the Treasury and Health and Human Services departments.
The report, which the agencies are required to file regularly to Congress, also detailed the results of secret shopper surveys of more than 4,300 mental health providers listed in insurance directories and found an “alarming proportion” were “unresponsive or unreachable.” Such error-ridden plans, commonly known as ghost networks, make it harder for patients to get the treatment they need, ProPublica has previously found.
Since 2021, the Labor Department has addressed violations in health plans that serve more than 7 million people, according to the report. The agency has worked to remedy the problems by seeking changes to plan provisions, policies and procedures, as well as working to ensure wrongly denied claims were paid.
continues....
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
by T. Christian Miller, ProPublica; Patrick Rucker, The Capitol Forum; and David Armstrong, ProPublica
Oct. 23, 2024, 1:30 p.m. EDT
Change Appearance
Republish
Co-published with The Capitol Forum
Series: Uncovered: How the Insurance Industry Denies Coverage to Patients
More in this series
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
Reporting Highlights
Dialing for Dollars: America’s largest insurers hire EviCore to make decisions on whether to pay for care for more than 100 million people.
“The Dial”: EviCore uses an algorithm that allows it to adjust the chances that company doctors will screen prior authorization requests, increasing the possibility of denials.
Lucrative Deals: Some EviCore contracts are based on how deeply the company can reduce spending on medical procedures. It tells insurers that it can provide a 3-to-1 return on investment.
These highlights were written by the reporters and editors who worked on this story.
Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.
But the insurance companies don’t always make these decisions. Instead, they often outsource medical reviews to a largely hidden industry that makes money by turning down doctors’ requests for payments, known as prior authorizations. Call it the denials for dollars business.
The biggest player is a company called EviCore by Evernorth, which is hired by major American insurance companies and provides coverage to 100 million consumers — about 1 in 3 insured people. It is owned by the insurance giant Cigna.
A ProPublica and Capitol Forum investigation found that EviCore uses an algorithm backed by artificial intelligence, which some insiders call “the dial,” that it can adjust to lead to higher denials. Some contracts ensure the company makes more money the more it cuts health spending. And it issues medical guidelines that doctors have said delay and deny care for patients.
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
https://propub.li/4gIto8d
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Total bullshit.
The Golden Age is 2 months away. And guess what….. you’re gonna love it! (teskeinc 11.19.24)
1998: Noblesville; 2003: Noblesville; 2009: EV Nashville, Chicago, Chicago
2010: St Louis, Columbus, Noblesville; 2011: EV Chicago, East Troy, East Troy
2013: London ON, Wrigley; 2014: Cincy, St Louis, Moline (NO CODE)
2016: Lexington, Wrigley #1; 2018: Wrigley, Wrigley, Boston, Boston
2020: Oakland, Oakland: 2021: EV Ohana, Ohana, Ohana, Ohana
2022: Oakland, Oakland, Nashville, Louisville; 2023: Chicago, Chicago, Noblesville
2024: Noblesville, Wrigley, Wrigley, Ohana, Ohana; 2025: Pitt1, Pitt2
(Published Oct. 2024)
https://propub.li/43fg1cI
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Doctors are left to walk a tightrope. Read more: https://propub.li/4i4mwU9
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you're finally here and I'm a mess................................................... nationwide arena columbus '10
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“We literally click and submit,” one former company doctor said.
(Published March 2023 with The Capitol Forum)
https://propub.li/3Foz1f7
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you're finally here and I'm a mess................................................... nationwide arena columbus '10
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another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Now, after pharma-bankrolled lawmakers killed pricing regs, Americans are charged the world's highest prices for the drug. https://www.levernews.com/youve-already-paid-6-billion-for-weight-loss-drugs-you-cant-afford/
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
And we've been fighting to get a new med for my son covered for about a month now too. It's just so ridiculous that we can pay 2k a month in premiums just to get denied prescriptions that our doctor is giving us.
I've said before, insurance fraud should go both ways. If a company or persons are wrongfully denying coverage to save money, they should be held to the same standard of fraud as someone who is faking an injury to get money.
Really does make no sense in California if you pay thousands a month and still end up paying more for services.