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Can Health Insurance Not Cover a Procedure Even After Pre-Authorization?
Healthcare professionals and patients consistently encounter a frustrating reality: pre-authorization doesn’t guarantee payment. One patient recently shared their dilemma: “I’m suspicious as I’m reading stories of insurance proving approval, but then declining after the fact and patients being stuck with 10k+ bills.” This common concern reveals a critical gap in understanding how insurance pre-authorization actually works and why approved procedures can still result in unexpected bills. Pre-Authorization Is Not a Payment Guarantee Insurance industry professionals confirm what many patients discover
Noah Thomas
Can Having Two Health Insurances Cause More Problems Than Benefits?
“I’ve been on SSDI and Medicare Advantage (Cigna) for seven years. It’s my secondary insurance. My primary is Blue Cross Blue Shield from my husband’s job. It worked well for a while, but now it feels like having both may be more of a hindrance than anything.” This statement from a Reddit discussion captures the ongoing confusion surrounding Medicare Advantage versus supplemental insurance. Many patients are unsure whether maintaining two policies is beneficial or unnecessarily complicated. Across healthcare communities, both
Venkata Ramarao Sanka
Why Are Prior Authorizations Delaying Patient Care?
It appears like all my family’s meds need prior authorization now. This is crazy. That quote from a 23-year FEP BC/BS member has struck a chord across healthcare forums. For decades, their medications were approved without issue until recently. Suddenly, nearly every prescription for their family required prior authorization. The discussion on Reddit reveals growing frustration and confusion among healthcare professionals and patients alike. As one moderator explained, “Carriers can change the prescription formulary list to make a medication require
Emma Davis
How to Automate Claim Submission Timing in Your Billing Software?
Healthcare professionals are searching for ways to automate claim submission timing, especially when traveling or managing practices remotely. One practitioner asked: “Is there any way I can preset a claim and not submit it now but when the preset time is reached, the claim will be automatically submitted? I mean the treatment was completed today and I will traveling to another state tomorrow, so is there any software that I can preset a claim to be automatically filed on Friday?”
William Brown
Why EHR Charting Is Breaking Clinicians and How to Fix It?
Healthcare professionals across hospitals are reaching a breaking point with EHR documentation. One frustrated administrator captured the crisis perfectly: “Our hospital’s documentation burden is absolutely crushing morale. Nurses spend 3+ hours per shift just on charting, and our physicians are burning out from clicking through 15 screens just to document a basic encounter.” The desperation is real. After trying templates, macros, and voice recognition software, healthcare organizations are still losing the battle against documentation overload. Forum discussions reveal a common
William Brown
AI Prior Authorization Automation in Healthcare
Prior authorization has become one of the most grating parts of healthcare for both providers and patients. Healthcare professionals across forums are discussing whether AI could finally solve this administrative nightmare that delays critical medications and wastes countless staff hours. One practitioner captured the frustration perfectly: “I can’t count how many times the medicine we need has been put on hold just cuz.” The question isn’t just theoretical it’s about whether technology can eliminate a process that exists primarily to
Noah Thomas
Prior Authorization Denied: Medication Access Crisis
“I’ve been on the same medication for a couple years and when I tried to fill my prescription this month they wanted prior authorization Dr submitted and it was denied They submitted an appeal.” This patient’s experience captures a healthcare crisis that’s leaving thousands unable to access medications they desperately need. Patients report “I struggle really bad to function without it and have been doing so well with it,” yet insurance companies continue erecting barriers between prescribed treatments and those
Noah Thomas
Insurance Billing Outsourcing: Is It Right for Your Practice?
Healthcare professionals considering solo practice are asking critical questions in forums: “thinking of going solo from an OP clinic and doing my own thing. Anyone have experience of heard of outsourcing their billing to insurance? Seeing if this is a plausible thing as I have no experience with billing it myself, let alone a business.” The discussion reveals a common challenge facing healthcare professionals transitioning to independent practice: managing insurance billing without prior experience while building a new business. “No
William Brown
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