PayerWatch
Behind the sterile labels of “inpatient” versus “observation” care is a messy reality: clinicians and insurers often enter peer-to-peer reviews without a shared rulebook, turning what should be a clinical dialogue into a box-checking exercise. The speaker’s frustration points to a broader problem in U.S. healthcare utilization management—decisions about coverage can feel pre-decided,…
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Healthcare
Navigating Payer Denials: A Physician Advisor’s Perspective #2
A physician advisor recently described a case that should unsettle anyone who cares about fair, clinically grounded coverage decisions: a Medicaid patient arrived comatose from an overdose, was emergently intubated, developed aspiration pneumonia, and stayed through three midnights before leaving against medical advice. By any bedside standard, this is acute, unstable care—exactly what…
Deny This! with Brian McGraw - PayerWatch
Inside ERISA Denials: Why Employers May Be the Real Decision-Makers Behind Your Insurance Card
Insurance denials aren’t new, but they’re hitting a breaking point right now. As prior authorizations surge and patients face longer delays for everything from imaging to specialty drugs, more providers are realizing that the “payer” on the card often isn’t the one truly holding the reins. A growing share of Americans are covered…
Latest
Navigating Payer Denials: A Physician Advisor’s Perspective #2
A physician advisor recently described a case that should unsettle anyone who cares about fair, clinically grounded coverage decisions: a Medicaid patient arrived comatose from an overdose, was emergently intubated, developed aspiration pneumonia, and stayed through three midnights before leaving against medical advice. By any bedside standard, this is acute, unstable care—exactly what…
Inside ERISA Denials: Why Employers May Be the Real Decision-Makers Behind Your Insurance Card
Insurance denials aren’t new, but they’re hitting a breaking point right now. As prior authorizations surge and patients face longer delays for everything from imaging to specialty drugs, more providers are realizing that the “payer” on the card often isn’t the one truly holding the reins. A growing share of Americans are covered…
Laying Out the Landscape in Today’s Patient Monitoring
More and more hospital environments rely on continuous, high-quality data to support faster clinical decisions, but much of today’s patient monitoring still varies widely by unit, device, and workflow. This episode kicks off a five-part Health and Life Sciences at the Edge series exploring The Future of Patient Monitoring. Intel’s Kaeli Tully, Solutions Engineer…
People-Centric HR in Practice: How Jen Schomer Turns Organizational Chaos into a Culture of Trust and Performance
In today’s whiplash workplace—where startups scale fast, funding dries up faster, and employee expectations keep evolving—HR isn’t a back-office function anymore. The rise of fractional leadership, remote teams, and constant regulatory change has forced companies to rethink how they support people while still hitting business goals. Leaders are realizing that “culture issues” often trace…
Latest Deny This! with Brian McGraw - PayerWatch
Deny This! with Brian McGraw - PayerWatch
Inside ERISA Denials: Why Employers May Be the Real Decision-Makers Behind Your Insurance Card
Insurance denials aren’t new, but they’re hitting a breaking point right now. As prior authorizations surge and patients face longer delays for everything from imaging to specialty drugs, more providers are realizing that the “payer” on the card often isn’t the one truly holding the reins. A growing share of Americans are covered…
Latest Physician Advisors - PayerWatch
Healthcare
Rebecca Interview: When Peer-to-Peer Reviews Stop Being About the Patient
Behind the sterile labels of “inpatient” versus “observation” care is a messy reality: clinicians and insurers often enter peer-to-peer reviews without a shared rulebook, turning what should be a clinical dialogue into a box-checking exercise. The speaker’s frustration points to a broader problem in U.S. healthcare utilization management—decisions about coverage can feel pre-decided,…
Navigating Payer Denials: A Physician Advisor’s Perspective #2
A physician advisor recently described a case that should unsettle anyone who cares about fair, clinically grounded coverage decisions: a Medicaid patient arrived comatose from an overdose, was emergently intubated, developed aspiration pneumonia, and stayed through three midnights before leaving against medical advice. By any bedside standard, this is acute, unstable care—exactly what…
