What We’re Reading: Appealing Insurance Denials; the Sackler Bankruptcy Settlement; Medicare Advantage Enrollment


The Mind-Boggling Labyrinth of Insurance Denials

Appealing insurance denials has become complex, with multiple levels of appeals and different processes for each insurer. A journalist from ProPublica tried to unravel the process and couldn’t. After interviewing more than 50 experts, she was no closer to figuring it out. This could be why only a small percentage of patient ever file appeals.

The Man who Fought the Sackler Bankruptcy Settlement

In 2019, Purdue announced a bankruptcy settlement that shielded the Sacklers — the family that became billionaires from the sale of OxyContin — from civil lawsuits and protected their wealth. In August of this year, the Supreme Court blocked the settlement. Forbes interviews the lawyer who fought the bankruptcy settlement.

Medicare Advantage Enrollment is Growing

More than half of eligible Medicare beneficiaries, or about 30.8 million people, are enrolled in Medicare Advantage in 2023, according to an analysis from KFF. This is up from 46% in 2021 and 39% in 2019. Enrollment in special needs plans — which restrict enrollment to specific types of beneficiaries with significant or relatively specialized care needs, or who qualify because they are eligible for both Medicare and Medicaid — increased by 24% between 2022 and 2023, and accounts for 19% of total Medicare Advantage enrollment in 2023.

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