Videos Healthcare

In “Fighting for Coverage,” a patient describes a double war: the physical fight to stay alive and the bureaucratic fight to prove to an insurer that her life is worth the cost. Her account spotlights a core tension in the U.S. system—coverage decisions are increasingly shaped by prior authorizations and desk-based reviewers who…

The sustainability of the healthcare system won’t be secured by another round of cost-cutting or clever benefit design alone, but by a hard cultural pivot toward alignment: payers, providers, employers, and patient advocates pulling on the same rope instead of grading each other on different exams. Right now we’ve built a maze that…

Patients shouldn’t have to become their own case managers just to access a hip replacement, transplant, or any other life-changing procedure; the moment they’re pushed into a paperwork fight, the system has already shifted its burden onto the sick. In a functional healthcare model, clinicians and their teams handle the insurer negotiations behind…

Physician advisors are becoming the quiet linchpin of hospital resilience in a reimbursement environment where insurers increasingly treat care like a spreadsheet exercise. As payers tighten criteria and automate denials, the gap between clinical reality and business logic widens—and without a skilled physician advisor (and a disciplined appeals pathway), health systems risk watching…

Payer denials used to feel like a series of personal affronts—clinicians and administrators trading war stories in hallways, certain they were being shortchanged but lacking the proof to do more than fume. Today, that fog should be lifting: with data warehouses, smarter analytics, and years of claims history, hospitals can pinpoint which payers…

Insurance denials have quietly become one of the most powerful forces shaping American healthcare, not through better outcomes but through a steady tightening of what insurers are willing to cover and when they’ll say so. The real scandal isn’t just that claims get rejected—it’s that the system rewards obstruction, pressuring hospitals to spend…

Healthcare in the U.S. often feels less like a covenant and more like a negotiation conducted on a tilted table, where insurers hold the rulebook and patients hold the receipt for their pain. The “two-midnight rule” and similar fixes were meant to tame arbitrary denials, yet the system keeps sprouting fresh loopholes because…

Medicare Advantage was sold as a smarter, more efficient way to care for seniors, but too often the efficiency seems to land on the wrong side of the patient–provider relationship. When plans deny or delay needed services through opaque rules and weak oversight, beneficiaries feel it first—in missed therapies, postponed procedures, and a…

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,…