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Insurance Denials of Doctor-Ordered Scans Highlight Challenges for Patients in 2026

Insurance Denials of Doctor-Ordered Scans Highlight Challenges for Patients in 2026

Actress Christy Carlson Romano recently shared her experience of having a PET scan denied by her insurance, despite a doctor's recommendation following a concerning cancer screening result. This situation is not unique, as many patients face similar denials, often due to issues like lack of prior authorization or billing code mismatches. PET scans can cost between $1,500 and $6,000, and about 34% of prior authorization requests for these scans are initially denied by insurers. A new federal rule effective January 1, 2026, aims to address these issues by requiring insurers to respond to authorization requests more quickly.

Insurance Denials for Doctor-Ordered Scans: New Rules and Appeal Strategies for 2026

Insurance Denials for Doctor-Ordered Scans: New Rules and Appeal Strategies for 2026

In 2026, insurance denials for doctor-ordered scans, such as PET scans, remain a significant issue for patients, including celebrities like Christy Carlson Romano. Romano, known for her roles in 'Even Stevens' and 'Kim Possible,' shared her experience of having a cancer screening denied by her insurer, highlighting a common frustration among patients. The denial of such scans often leaves patients with hefty out-of-pocket costs, ranging from $1,500 to $6,000. A new federal rule, effective January 1, 2026, mandates insurers to respond to standard prior authorization requests within seven days and urgent requests within 72 hours, reducing the previous 14-day period. Additionally, starting March 31, 2026, Medicare Advantage, Medicaid, and ACA marketplace insurers must publicly disclose their prior authorization approval and denial rates, allowing patients to compare plans more effectively.

Senator Cantwell Raises Concerns Over AI-Induced Delays in Medicare Pilot Program

Senator Cantwell Raises Concerns Over AI-Induced Delays in Medicare Pilot Program

Senator Maria Cantwell of Washington has expressed concerns about the Wasteful and Inappropriate Service Reduction (WISeR) Model, a Medicare pilot program that uses artificial intelligence to approve medical procedures. The program, implemented in six states, has reportedly caused significant delays in treatment for seniors, with some waiting weeks for procedures that previously required minimal prior authorization. The Centers for Medicare and Medicaid Services (CMS) introduced the WISeR model to reduce waste and fraud by requiring AI-driven prior authorization for certain services. However, Cantwell argues that the program's incentive structure financially rewards contractors for delaying or denying care, potentially restricting access for vulnerable seniors.

Analysis-Medicare Advantage health plans may cut extra benefits in 2027

Analysis-Medicare Advantage health plans may cut extra benefits in 2027

By Amina Niasse NEW YORK, May 1 (Reuters) - Americans enrolled in Medicare Advantage health plans should expect to see fewer extra benefits like gym memberships and vision and dental coverage next year, investors and industry experts say.

Alignment Healthcare Reports Profit Amid Eased Medicare Advantage Costs

Alignment Healthcare Reports Profit Amid Eased Medicare Advantage Costs

Alignment Healthcare Reports Profit Amid Eased Medicare Advantage Costs

Miami Judge Orders Oscar Health to Cover Cancer Patient's $48K Drug, Setting Precedent for Insurance Disputes

Miami Judge Orders Oscar Health to Cover Cancer Patient's $48K Drug, Setting Precedent for Insurance Disputes

A Miami-Dade judge has ruled that Oscar Health Insurance must cover a $48,500 oral medication for a Stage 4 pancreatic cancer patient, Pablo Langesfeld. The dispute began when Langesfeld's doctor prescribed the drug Avmapki Fakzynja Co Pack after chemotherapy failed. Oscar Health denied coverage, citing the drug's lack of federal approval for pancreatic cancer. However, the drug is FDA-approved for ovarian cancer and has an 'orphan drug' designation for pancreatic cancer research. Judge Migna Sanchez-Llorens found Oscar Health's policy definitions ambiguous, ruling in favor of the patient as required by Florida law.

Report Highlights Racial Disparities in Iowa's Healthcare System

Report Highlights Racial Disparities in Iowa's Healthcare System

A recent report by the Commonwealth Fund reveals significant racial and ethnic disparities in Iowa's healthcare system. The State Health Disparities Report, which examines state-level health data, found that while disparities in Iowa are less severe compared to neighboring states, they are still pronounced. White Iowans rank in the 82nd percentile nationally for healthcare outcomes, whereas Hispanic and Black Iowans rank in the 18th and 19th percentiles, respectively. The report highlights that 6% of white Iowans aged 19 to 64 are uninsured, compared to 12% of Asian American, Native Hawaiian, and Pacific Islander Iowans, 19% of Black Iowans, and 23% of Hispanic Iowans. The report suggests that recent federal policy changes, such as Medicaid spending reductions and the expiration of Affordable Care Act tax credits, could exacerbate these disparities.

Trump administration defers $91M more in Minnesota Medicaid funding citing fraud vulnerabilities

Trump administration defers $91M more in Minnesota Medicaid funding citing fraud vulnerabilities

The Trump administration has deferred an additional $91 million in Medicaid funding to Minnesota, citing concerns about fraud in state-run programs

Agnesian HealthCare Foundation Awards $5,000 Grant to Combat Food Insecurity at St. Agnes Hospital

Agnesian HealthCare Foundation Awards $5,000 Grant to Combat Food Insecurity at St. Agnes Hospital

The Agnesian HealthCare Foundation has provided a $5,000 grant to support food-insecure patients at SSM Health St. Agnes Hospital in Fond du Lac. This initiative, in collaboration with the Fondy Food Pantry, aims to supply food bags to patients identified as food insecure during their hospital intake process. The program is part of SSM Health's broader efforts to address food insecurity, particularly among Medicare and Medicaid patients, by connecting them with necessary food resources. The initiative, which began as a pilot in 2024, has been expanding and currently serves approximately 80 to 110 patients annually. It includes provisions for patients who may not have access to cooking facilities, ensuring they have nutritious options upon discharge.

Nebraska Implements Medicaid Work Requirements, Risking Coverage Loss for Thousands

Nebraska Implements Medicaid Work Requirements, Risking Coverage Loss for Thousands

Nebraska has become the first state to enforce Medicaid work requirements under a new federal mandate, potentially affecting over 25,000 residents. The requirements apply to able-bodied adults, with exemptions for caretakers, the medically frail, and certain protected communities. Nebraska is implementing these changes eight months ahead of the January 2027 deadline, despite lacking federal implementation guidance. The move has drawn criticism for being rushed and potentially unmanageable. The state's decision is part of a broader trend following a 2025 tax and spending law that reduced Medicaid funding and mandated work requirements for coverage.

Reeves establishes Mississippi office for Rural Health Transformation Program funds

Reeves establishes Mississippi office for Rural Health Transformation Program funds

Gov. Tate Reeves has announced the creation of an office to manage federal funds for improving rural healthcare in Mississippi

Medicare Portal Exposes Health Providers' Social Security Numbers, Raising Security Concerns

Medicare Portal Exposes Health Providers' Social Security Numbers, Raising Security Concerns

The Trump administration's initiative to modernize healthcare technology has inadvertently led to the exposure of health providers' Social Security numbers through a Medicare portal database. The Centers for Medicare and Medicaid Services (CMS) created a directory to help seniors identify which doctors accept specific insurance plans. However, a publicly accessible database used to populate this directory contained providers' Social Security numbers linked to their names and other identifying information. The Washington Post discovered the exposure and informed CMS, which has since taken steps to address the issue. CMS officials stated that the problem arose from incorrect data entries by providers, leading to the exposure of sensitive information.