Dana Kelso Spradling says she's dealing with an insurance nightmare, after the medication she had already received a prior ...

California is one of 31 states that passed laws in 2025 limiting insurance companies’ use of prior authorization to approve ...

New Medicaid prior-authorization rules have advocates in Connecticut concerned about patients losing access to their prescription drugs.

Health insurance companies increasingly require medical providers to obtain approval before delivering the costliest forms of treatment to patients. This has helped curb wasteful expenditure but also ...

State insurance regulators unveiled sweeping prior authorization reforms that would scrap pre-approval requirements for “many routine and essential” health care services, Gov. Maura Healey announced ...

A six-state pilot program will target 'wasteful care' under Medicare Medicare programs in six states will face prior authorizations under a new pilot program. Traditional Medicare in six states will ...

Electronic health record providers are starting work that could transform how nursing homes grapple with prior authorization requests and length of stay determinations. Rules finalized earlier this ...

Prior authorization (PA) is a utilization management technique used by health insurers that requires providers to seek approval from the insurance plan before the plan will agree to pay for a covered ...

Leah Kovitch was pulling invasive plants in the meadow near her home one weekend in late April when a tick latched onto her leg. She did not notice the tiny bug until Monday, when her calf muscle ...

The lawmakers argue the CMS innovation center model, which will implement AI-backed prior authorization for some services in six states, will add red tape and limit access to care. The bill, called ...

Prior authorization is a barrier to accessing medications for opioid use disorder (MOUD). Although private insurance covered about one-third of patients with OUD in 2023, the understanding of prior ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...