As Negative Prior Auth Accounts Mount, Blues Plans Get Caught in Provider Fray

  • Nov 07, 2024

    As reports continue to emerge of major insurers deploying prior authorization to boost profits, contract disputes between health systems and Medicare Advantage plans across the U.S. also persist. While it’s not unusual for negotiations to heat up this time of year, the ones that are playing out in the public eye appear to have more do to with payment delays and care denials than with payment rates, which historically have been the sticking point. Rochester, New York-based Excellus BlueCross BlueShield (BCBS), for one, was caught by surprise when one major network provider publicly accused it of routinely denying claims. Read more
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  • Lauren Flynn Kelly

    Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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