Coverage Navigation Strategies

Insurer Claims of Prior Authorization Cutbacks Draw Skepticism From Physicians and Policy Experts

George Padron
Prior Authorization & Appeals, Medicare/Medicaid Updates, Coverage Navigation Strategies, Appeals & Denials Management, Reimbursement Changes, Practice Management, Regulatory & Legislative Updates | Apr 13, 2026
AHIP says insurers eliminated 6.5M prior authorizations for medical services, but critics call the announcement vague and say prescription drugs were excluded.

Vision Benefits and Medical Coverage: Network Complexity Creates Patient Confusion

Sonia Reyes
Prior Authorization & Appeals, Medicare/Medicaid Updates, Patient Support Resources, Healthcare Headlines, Coverage Navigation Strategies, Appeals & Denials Management, Patient-Reported Outcomes | Feb 3, 2026
A Medicare Advantage member faced denial for glaucoma testing when the clinic held in-network status for vision benefits but not medical coverage in the same plan.

ACA Bronze Plan Enrollments Surge as Subsidies Expire

George Padron
Healthcare Headlines, Coverage Navigation Strategies | Jan 29, 2026
ACA bronze plan enrollments surge for 2026 as enhanced subsidies expire, with state data showing significant tier redistribution toward higher-deductible coverage.

Maternal Mortality Data Challenges Health Plan Risk Assessment Models

Sonia Reyes
Coverage Navigation Strategies, Public Health Initiatives, Care Coordination | Jan 25, 2026
Updated mortality data reveal pregnancy carries a 44 to 70 times higher death risk than abortion, challenging managed care quality metrics and risk stratification protocols.

New Federal Guidelines Require Coverage of At-Home Cervical Cancer Screening

Sonia Reyes
Patient Support Resources, Healthcare Headlines, Policy & Legislation, Coverage Navigation Strategies, Reimbursement Changes, Breast Cancer | Jan 13, 2026
New HRSA guidelines mandate insurance coverage of self-collected HPV tests for cervical cancer screening without patient cost-sharing, effective January 2027.

Risk-Based Breast Cancer Screening Demonstrates Safety and Resource Efficiency

George Padron
Oncology Care, Digital Therapeutics, Medicare/Medicaid Updates, Real World Evidence, Precision Medicine, Biomarker & Genomic Testing, Healthcare Headlines, Policy & Legislation, Coverage Navigation Strategies, Reimbursement Changes | Dec 14, 2025
WISDOM trial showed risk-stratified breast screening matches annual mammography for safety while optimizing resource use and identifying prevention candidates.

Coverage Navigation Strategies

Insurer Claims of Prior Authorization Cutbacks Draw Skepticism From Physicians and Policy Experts

Vision Benefits and Medical Coverage: Network Complexity Creates Patient Confusion

ACA Bronze Plan Enrollments Surge as Subsidies Expire

Maternal Mortality Data Challenges Health Plan Risk Assessment Models

New Federal Guidelines Require Coverage of At-Home Cervical Cancer Screening

Risk-Based Breast Cancer Screening Demonstrates Safety and Resource Efficiency

Latest News

Dr. Eleonora Teplinsky on ASCO 2026 GLP-1 and Breast Cancer Prevention Data

Study Finds Parkinson's Genetic Yield Varies from 0.4% to 10.7% Based on Ancestry

Merck's Oral PCSK9 Inhibitor Approval Undercuts Injectables

Air Quality Alerts Blanket the Northeast as Canadian Smoke Pushes the AQI Into the Unhealthy Band

Care Partners Often Overlooked Patient Portal Users

Who We Are

Connect