Private Insurance

Claims chaos: barriers to health insurance: Prior authorization, denials & appeals

Claims chaos: barriers to health insurance: Prior authorization, denials & appeals

NAIC Consumer Reps. Carl Schmid and Deb Darcy discuss barriers consumers face in accessing healthcare through the high number of prior authorizations and the appeals and denials process, and request the NAIC develop a workstream that improves data collection, and consumer awareness of the appeals process, update model laws, and better enforcement of federal and state laws and regulations.

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Tackling copay accumulator and maximizers

Tackling copay accumulator and maximizers

Carl Schmid participates in the “Prescription for Better Access” podcast with Lauren Crawford Shaver and hosts Mark Hansan and Dr. Scott Howell to examine how PBM copay accumulator and maximizer policies harm patients by not counting copay assistance toward patient out-of-pocket costs and deductibles, and what can be done to keep prescription drugs accessible and affordable.

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Discrimination in prescription drug formularies

Discrimination in prescription drug formularies

Carl Schmid discusses discrimination in prescription drug formularies, demonstrating how some PBMs and private insurers violate ACA provisions and hurt patients by placing life-saving prescription drugs on higher cost tiers.

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