Latest news with #healthInsurance
CNN
01-07-2025
- Health
- CNN
Thousands of cancer patients fear disruptions in care due to insurance contract dispute
FacebookTweetLink Marla Puccetti spent all day Monday on the phone, urgently trying to reach someone at her health insurance company and the hospital that's treating her cancer. 'I've been on hold all day long, basically,' said Puccetti, 53, who co-owns a restaurant with her partner in Narrowsburg, New York. Her health insurer, UnitedHealthcare, and her hospital, Memorial Sloan Kettering Cancer Center, have been locked in a contract dispute that wasn't resolved by the overnight deadline. That means Puccetti and roughly 19,000 other cancer patients insured by UnitedHealthcare who are receiving treatment at Memorial Sloan Kettering are no longer in-network at the cancer center, it announced. They may face higher bills for their cancer treatment starting Tuesday. Puccetti doesn't have out-of-network coverage on her current plan, so she would have to pay the full cost of her care, which she can't afford. But going anywhere but MSK for her treatment is unthinkable. 'It's terrifying. I don't want to go anywhere else,' she said. 'All of my doctors are there. All of my surgeons are there. I feel like they saved my life.' The insurer and the cancer center, which has locations in New York City, New York state and New Jersey, had been in tense contract negotiations over rate increases that MSK said it needed to keep up with the cost of care. UnitedHealthcare said MSK asked for a 30% increase in payments for its facilities and physicians, as well as a 36% increase for its cancer center. The insurer said the increases would drive up costs for consumers by $405 million over the next two years. 'We will remain at the negotiating table as long as it takes to renew our relationship with MSK. We ask MSK to join us there and to reach an agreement people and employers can afford,' UnitedHealthcare CEO Junior Harewood said in a statement Monday. United said it delivered proposals to MSK on June 23 and June 30, but the hospital has so far declined the offers. The insurer says it already reimburses MSK at rates significantly higher than other systems specializing in cancer care in the region. Dr. Cardinale Smith, chief medical officer for MSK, disputes the idea that their cancer center is driving up the cost of care for patients. She says their cost of care is actually 4% to 16% lower than at comparable hospitals in the area. 'Our patients are getting better outcomes for total lower cost of care,' Smith said. UnitedHealthcare is the nation's largest insurer, and she says hers isn't the only system that's being squeezed in contract negotiations with them. 'This is happening in other institutions as well, and it reflects what I think is a deeper tension in our health care system where there are financial priorities that are really being placed ahead of what's best for patients,' Smith said. In 2021, Puccetti was diagnosed with breast and then cervical cancer just a few weeks apart. After a mastectomy and a hysterectomy, her breast cancer is in remission, but her cervical cancer has been tougher to snuff out. It has returned three times. She has tallied 60 rounds of radiation and 100 rounds of chemotherapy and has lost her hair three times. Her tumor is in a bad spot, she says, attached to both her bladder and her bowel. Doctors said they could remove it surgically, but it would leave her dependent on bags hanging outside her body to collect urine and stool for the rest of her life, a situation she found untenable. Now, she's on an immunotherapy drug that helps her body recognize and attack the cancer, with a goal of keeping it stable. She has been making the two-hour trip from her home in upstate New York to MSK about once a week for the past few months for tests to help doctors keep tabs on the tumor. She got a letter just two weeks ago from UnitedHealthcare that said MSK might not be in her network starting July 1. 'It all came as a shock that this was actually happening,' she said. On Monday, the two parties said they'd been unable to reach an agreement, leaving thousands of patients uncertain whether they'll be able to afford to continue their care at MSK. In a statement to CNN, UnitedHealthcare said patients who are in active on ongoing treatment with an MSK provider when they go out of network will automatically receive continuity of care, meaning their care will still be covered at in-network rates for at least 90 days after the change takes effect. The insurer said patients don't need to apply for the extended benefits — they will be automatically granted. Puccetti said she's unsure what she'll do. She's been researching other coverage options. Her UnitedHealthcare plan costs $3,200 a month, she says. It does provide some coverage, but she still owes 'thousands and thousands' in out-of-pocket costs. Through it all, she's worked full-time at the restaurant, cooking, tending bar, keeping the books. She applied for financial aid through Memorial Sloan Kettering but hasn't heard whether she qualifies. Now, she says, she'll have to find an alternative. 'Everyone kept saying, 'well, don't panic, because they're going to come to a resolution.' So I tried not to panic, but how can you not?' she said.
CNN
01-07-2025
- Health
- CNN
Thousands of cancer patients fear disruptions in care due to insurance contract dispute
FacebookTweetLink Marla Puccetti spent all day Monday on the phone, urgently trying to reach someone at her health insurance company and the hospital that's treating her cancer. 'I've been on hold all day long, basically,' said Puccetti, 53, who co-owns a restaurant with her partner in Narrowsburg, New York. Her health insurer, UnitedHealthcare, and her hospital, Memorial Sloan Kettering Cancer Center, have been locked in a contract dispute that wasn't resolved by the overnight deadline. That means Puccetti and roughly 19,000 other cancer patients insured by UnitedHealthcare who are receiving treatment at Memorial Sloan Kettering are no longer in-network at the cancer center, it announced. They may face higher bills for their cancer treatment starting Tuesday. Puccetti doesn't have out-of-network coverage on her current plan, so she would have to pay the full cost of her care, which she can't afford. But going anywhere but MSK for her treatment is unthinkable. 'It's terrifying. I don't want to go anywhere else,' she said. 'All of my doctors are there. All of my surgeons are there. I feel like they saved my life.' The insurer and the cancer center, which has locations in New York City, New York state and New Jersey, had been in tense contract negotiations over rate increases that MSK said it needed to keep up with the cost of care. UnitedHealthcare said MSK asked for a 30% increase in payments for its facilities and physicians, as well as a 36% increase for its cancer center. The insurer said the increases would drive up costs for consumers by $405 million over the next two years. 'We will remain at the negotiating table as long as it takes to renew our relationship with MSK. We ask MSK to join us there and to reach an agreement people and employers can afford,' UnitedHealthcare CEO Junior Harewood said in a statement Monday. United said it delivered proposals to MSK on June 23 and June 30, but the hospital has so far declined the offers. The insurer says it already reimburses MSK at rates significantly higher than other systems specializing in cancer care in the region. Dr. Cardinale Smith, chief medical officer for MSK, disputes the idea that their cancer center is driving up the cost of care for patients. She says their cost of care is actually 4% to 16% lower than at comparable hospitals in the area. 'Our patients are getting better outcomes for total lower cost of care,' Smith said. UnitedHealthcare is the nation's largest insurer, and she says hers isn't the only system that's being squeezed in contract negotiations with them. 'This is happening in other institutions as well, and it reflects what I think is a deeper tension in our health care system where there are financial priorities that are really being placed ahead of what's best for patients,' Smith said. In 2021, Puccetti was diagnosed with breast and then cervical cancer just a few weeks apart. After a mastectomy and a hysterectomy, her breast cancer is in remission, but her cervical cancer has been tougher to snuff out. It has returned three times. She has tallied 60 rounds of radiation and 100 rounds of chemotherapy and has lost her hair three times. Her tumor is in a bad spot, she says, attached to both her bladder and her bowel. Doctors said they could remove it surgically, but it would leave her dependent on bags hanging outside her body to collect urine and stool for the rest of her life, a situation she found untenable. Now, she's on an immunotherapy drug that helps her body recognize and attack the cancer, with a goal of keeping it stable. She has been making the two-hour trip from her home in upstate New York to MSK about once a week for the past few months for tests to help doctors keep tabs on the tumor. She got a letter just two weeks ago from UnitedHealthcare that said MSK might not be in her network starting July 1. 'It all came as a shock that this was actually happening,' she said. On Monday, the two parties said they'd been unable to reach an agreement, leaving thousands of patients uncertain whether they'll be able to afford to continue their care at MSK. In a statement to CNN, UnitedHealthcare said patients who are in active on ongoing treatment with an MSK provider when they go out of network will automatically receive continuity of care, meaning their care will still be covered at in-network rates for at least 90 days after the change takes effect. The insurer said patients don't need to apply for the extended benefits — they will be automatically granted. Puccetti said she's unsure what she'll do. She's been researching other coverage options. Her UnitedHealthcare plan costs $3,200 a month, she says. It does provide some coverage, but she still owes 'thousands and thousands' in out-of-pocket costs. Through it all, she's worked full-time at the restaurant, cooking, tending bar, keeping the books. She applied for financial aid through Memorial Sloan Kettering but hasn't heard whether she qualifies. Now, she says, she'll have to find an alternative. 'Everyone kept saying, 'well, don't panic, because they're going to come to a resolution.' So I tried not to panic, but how can you not?' she said.
Health Line
25-06-2025
- Health
- Health Line
A Guide to Making Your First Doctor's Appointment
Making your first doctor's appointment can feel like a big step and may leave you feeling like you don't know where to start. However, taking time to prepare and understanding what to expect can help make the process easier. Making your first doctor's appointment can feel overwhelming. The process can often involve more than just picking up the phone. You will typically need to gather health insurance information, fill out paperwork, and research doctors in your area to find the right care. If you're navigating the healthcare system for the first time, you may feel like you don't know where to start. However, there are several steps you can take to feel prepared and ensure you can take an active role in your healthcare. Read on to learn how you can find a doctor that meets your individual needs, how to schedule your first appointment, and how you can prepare. Finding the right doctor When searching for a doctor, it's important to consider: if their practice location is convenient and accessible for you, particularly if you have mobility needs what experience they have and whether they specialize in your needs what conditions they treat and what procedures they offer if they are accepting new patients what credentials they have and whether they are board certified whether they accept your insurance plan It can also be helpful to ask for recommendations from friends and family members and explore online reviews. If you have a chronic condition, advocacy and online support groups can help you find doctors who specialize in your condition and understand your needs. » Find doctors near you with Healthline FindCare. Understanding your health plan Before scheduling your first doctor's appointment, it's important to understand how your health plan works. Your health insurance company, state Medicaid, or Children's Health Insurance Program (CHIP) agency can answer any questions you have. This can include: Checking if a doctor is in-network or out-of-network: If a doctor is in-network, they have a contract with your provider, which will cover all or part of the cost. However, if they are out-of-network, your plan may only cover a small percentage of the cost, leaving you to pay the majority of the charge yourself. Understanding if you need to have a primary care physician (PCP): Some health insurance plans require you to choose a PCP when you sign up. If you have yet to select one, your insurance company may have an approved list you need to choose from. Asking about cost-sharing policies: You can speak with your provider beforehand to understand what services they will cover, how much of the total cost they will cover, and how much you are expected to pay out of pocket. Scheduling an appointment When making the appointment, it can be helpful to mention the following: Your name, and that you are a new patient. If you want to speak with a particular doctor, and why you would like to see them. The name of your insurance plan, or that you are enrolled in Medicaid or have CHIP coverage. If you require any accommodations, such as requesting: a language interpreter accessible parking assistance to get to the examination room Confidentiality in healthcare: Your rights as a minor As a minor, you may have the right to access some forms of healthcare, such as sexual health and mental health support, without parental involvement. However, this depends on the state you live in. When scheduling your appointment, it can be helpful to ask the clinic or doctor's office about the laws in your state. They can inform you if your care and documentation will be kept confidential. Taking time to prepare for your first doctor's appointment can help you feel well-equipped to communicate your health needs and make the most of your time. Steps you can take to prepare for your first appointment include: identifying what you would like to achieve from your appointment taking the time to think about what questions you'd like to ask and writing them down beforehand preparing anything you need to bring with you, such as: your health insurance information your medical records information about your family health history any medications and supplements you are taking any health questionnaires or forms » LEARN MORE: How to Prepare for a Doctor's Appointment
Tahawul Tech
24-06-2025
- Business
- Tahawul Tech
American based insurance giant suffers cyber breach
Cybercriminals recently breached U.S. insurance giant Aflac, potentially putting Social Security numbers, insurance claims and health information at risk. This incident marks the latest in a spree of targeted hacks against the U.S. insurance industry. With billions of dollars in annual revenue and tens of millions of customers, Aflac is the biggest victim yet in the ongoing digital assault on US insurance companies that has the industry on edge and the FBI and private cyber experts scrambling to contain the fallout. Erie Insurance and Philadelphia Insurance Companies have also reported hacks, which in those cases have caused widespread disruptions to IT systems used to serve customers. All three insurance-company hacks are consistent with the techniques of a young and rampant cybercrime group known as Scattered Spider. 'This attack, like many insurance companies are currently experiencing, was caused by a sophisticated cybercrime group', Aflac said in a recent statement, without naming Scattered Spider. Aflac said it 'stopped the intrusion within hours' after discovering it last week, that no ransomware was deployed, and that it continues to serve its customers. It was too early to tell, the company said, how much customer information may have been stolen, but the potential exposure is vast. Aflac is one of the largest providers of supplemental health insurance in the US for medical expenses that aren't covered by a primary provider. The hackers used 'social engineering' to worm their way into its network, according to Aflac. That tactic can involve duping someone into revealing security information to help gain access to a network. It's a hallmark of Scattered Spider attackers, who are known to pose as tech support to infiltrate big corporations. The loose group of cybercriminals is considered dangerous and unpredictable, in part because it is believed to be comprised of youths in the US and the UK known for aggressively extorting their victims. Scattered Spider shot to infamy in September 2023 when they were linked to a pair of multimillion-dollar hacks on famous Las Vegas casinos and hotels MGM Resorts and Caesars Entertainment. The hackers' tactics, and the way they target big swaths of American industries at a time, has cybersecurity executives pleading with companies to be wary of suspicious phone calls to their employees. Just last month, they were suspects in multiple cyberattacks on American retail companies. 'If Scattered Spider is targeting your industry, get help immediately,' said Cynthia Kaiser, who until last month was deputy assistant director of the FBI's Cyber Division and oversaw FBI teams investigating the hackers. 'They can execute their full attacks in hours. Most other ransomware groups take days'. Scattered Spider often registers web domains that look very much like trusted help desks that companies use for IT support, the cybersecurity firm Halcyon, where Kaiser now works, says in a forthcoming report. While concerns about Iranian cyber capabilities are in the news because of the Israel-Iran war, 'the threat I lose sleep over is Scattered Spider', said John Hultquist, chief analyst at Google's Threat Intelligence Group. 'They are already taking food off shelves and freezing businesses. The Iranian hackers may not even have Internet access, but these kids are in play right now'. Source: CNN Image Credit: Stock Image
Yahoo
23-06-2025
- Business
- Yahoo
Blue Shield of California Announces Actions to Simplify Prior Authorization Process
Blue Cross and Blue Shield companies aim to improve the prior authorization process to make health care safer, effective and more accessible OAKLAND, Calif., June 23, 2025 /PRNewswire/ -- As part of its mission to help members access quality, affordable health care, Blue Shield of California announced today a series of improvements to the prior authorization process. Alongside other national insurance providers, Blue Shield and other Blue Cross Blue Shield companies announced six commitments that will make the process faster, more seamless and more streamlined. "Our members deserve safe, evidence-based, high-value care without delays. That's why we're committed to these prior authorization reforms to make the process faster, simpler and less burdensome," said Mike Stuart, interim president and CEO, Blue Shield of California. "Blue Shield of California has been actively advancing in this direction through our Prior Authorization Reimagined initiative, which was introduced last year, and we are proud to be part of a broader movement." As part of today's announcement, Blue Shield is committing to: Standardizing provider submissions for electronic prior authorization, giving doctors more time for patients by lessening administrative burden. Further reducing the use of prior authorization for certain in-network medical services by 2026. Ensuring a seamless process for members who switch health insurance companies by honoring their previous health insurance company's prior authorization approvals for benefit-equivalent in-network services as part of a 90-day transition period, by 2026. Making the process more transparent by ensuring our communications to members about prior authorization are clear and contain personalized information, including what is needed to support approval, next steps and available appeal processes. Fast-tracking responses for electronic prior authorization requests by committing to answering at least 80% of requests in near real-time in 2027. Affirming that licensed physicians personally lead reviews of unapproved prior authorization requests. "Improving the prior authorization process will help us create an efficient, affordable and sustainable healthcare system for everyone," said Stuart. "There's real power in the Blues working together to move the industry forward, and these joint commitments reflect our shared determination to put members first while driving more affordable care." About Blue Shield of California Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. The health plan is a tax paying, nonprofit, independent member of the Blue Shield Association with 6 million members, over 7,500 employees and more than $25 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. The company has contributed more than $60 million to Blue Shield of California Foundation in the last three years to have an impact on California communities. For more news about Blue Shield of California, please visit Or follow us on LinkedIn or Facebook. About the Blue Cross Blue Shield AssociationThe Blue Cross and Blue Shield Association is a national federation of 33 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. For more information on BCBSA and its member companies, please visit About AHIPAHIP is the national trade association representing the health insurance industry. AHIP's members provide health care coverage, services and solutions to more than 200 million Americans. We are committed to market-based solutions and public-private partnerships that make high-quality coverage and care more affordable, accessible and equitable for everyone. For more information, visit CONTACT: Mark SeeligBlue Shield of California 510-607-2359 media@ View original content to download multimedia: SOURCE Blue Shield of California Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
