Insurance denials and prior authorization

“Stop insurers from delaying or denying medically necessary care.”

“Hold insurance companies accountable for driving up prices. Hold insurance companies accountable by lowering premiums and eliminating surprise bills, hidden fees, and denials that put profits over patients.”

“It’s time to ban health insurance companies from denying the care your doctor says you need. And if they try to deny your claims, we’ll fine them.”

“Your care should be between you and your doctor. You work too hard and pay too much for the insurance companies to prevent you from getting the treatment your doctor prescribes.”

“Prevent healthcare industry middlemen from denying care and medications prescribed by doctors.”

“Roy Cooper would lower health care costs by making sure that doctors make decisions about your health care, not insurance companies. Roy will work to reverse the Affordable Care Act tax credit expiration and cuts to Medicaid that have driven up health care costs for everyone; and put patient care first at hospitals. He’d also cap annual out-of-pocket costs for prescription drugs, and require Medicare to broaden negotiations with drug makers to make medicines more affordable.”

“Let doctors decide about health care, not insurance bureaucrats. End insurance company runarounds by allowing doctors to make coverage decisions, and reform insurance company reviews that result in denial of coverage for what a doctor says you need.”

“Roy Cooper believes that doctors should decide your health care, not insurance companies and he’d reverse the Affordable Care Act tax credit expiration and cuts to Medicaid that leave people without the coverage they need and drive up prices for everyone. He’d also require Medicare to broaden negotiations with drug makers to make prescriptions more affordable and strengthen oversight of hospital mergers that put profits over patients. He’d crack down on pharmacy benefit managers that pocket savings instead of passing them on to patients, curb surprise billing and cap annual out-of-pocket costs for prescription drugs. He’d prevent medical debt by requiring hospitals to auto-enroll patients in charity care and increase enforcement of upfront pricing to make health care costs more transparent.”

“In the Senate, I’ll fight insurance companies that send you big bills you don’t expect and deny care a doctor says you need.”

“I’m Roy Cooper, and I have a plan to stop insurance companies from ripping you off. And denying care a doctor says you need.”

“Peggy believes it’s time to ban insurance companies from using prior authorization processes for care. Too many Minnesotans have sat on the phone and begged their insurance company to cover a prescription medication, a treatment, or a surgery. A stranger behind a desk or an AI algorithm shouldn’t be able to deny you care your doctor prescribed.”

“Cut waste, fraud, and abuse in Medicare without touching anyone’s benefits. Medicare often pays about 2.5 times more for the same outpatient service in a hospital than in a doctor’s office — so paying one fair rate regardless of where care is delivered (“site-neutral”) could save more than $150 billion over a decade. Private Medicare Advantage plans, meanwhile, are projected to be overpaid by roughly $76 billion in 2026 because they document members as sicker than they really are. These are real opportunities for Republicans and Democrats to save billions in taxpayer dollars. Adam would go after both problems, and he would reform prior authorization so insurance paperwork cannot delay or deny care that doctors say patients need. This should be common ground.”

“Healthcare decisions should be made by patients and their doctors, not politicians and insurance companies”

“Pass legislation requiring insurers to fairly and promptly reimburse rural hospitals, cutting the enormous administrative costs of fighting endless denials”

“Ban health insurance companies from denying authorization for necessary procedures that your doctor says you need, and cap co-pays so that you can actually afford your care.”

“Let doctors decide about health care, not insurance bureaucrats. End insurance company runarounds by allowing doctors to make coverage decisions, and reform insurance company reviews that result in denial of coverage for what a doctor says you need.”

“Ban AI-based prior authorization. Automated denial systems are overriding physician judgment at scale, delaying or denying healthcare your doctor said you need. No algorithm should be able to deny care that a licensed physician has determined is necessary. Prior authorization decisions must be made by a licensed physician with full access to the patient’s record and subject to binding physician-to-physician review on appeal.”

“Cut waste, fraud, and abuse in Medicare without touching anyone’s benefits. Medicare often pays about 2.5 times more for the same outpatient service in a hospital than in a doctor’s office — so paying one fair rate regardless of where care is delivered (“site-neutral”) could save more than $150 billion over a decade. Private Medicare Advantage plans, meanwhile, are projected to be overpaid by roughly $76 billion in 2026 because they document members as sicker than they really are. These are real opportunities for Republicans and Democrats to save billions in taxpayer dollars. Adam would go after both problems, and he would reform prior authorization so insurance paperwork cannot delay or deny care that doctors say patients need. This should be common ground.”

“Cut the complexity of care for patients and providers by standardizing insurance paperwork and billing requirements, and modernizing the Prior Authorization process.”

“Reform the prior authorization system: Ensure that insurance companies do not arbitrarily deny patients the medication and treatments that their health care providers have determined necessary.”

“Fix prior authorization. Stop insurers from overruling your doctor with red tape.”

“We need Medicare for All. And until we get there, Scott will tackle healthcare affordability in Congress just like he has in the Legislature: by capping insulin at $35/month, forcing insurance companies to cover mental healthcare, reducing prior authorizations, lowering prescription drug prices, and working to reverse Trump's cuts to Medicaid and the Affordable Care Act.”

“AI No-Gos: AI may not deny medical care, autonomously fire weapons, conduct warrantless surveillance, replace human oversight in life-or-death decisions, or make hiring or firing decisions.”

“Ban AI-based prior authorization. Automated denial systems are overriding physician judgment at scale, delaying or denying healthcare your doctor said you need. No algorithm should be able to deny care that a licensed physician has determined is necessary. Prior authorization decisions must be made by a licensed physician with full access to the patient’s record and subject to binding physician-to-physician review on appeal.”

“AI shouldn’t be able to deny you healthcare. It shouldn’t be able to deny you a job. It shouldn’t be able to fire you. It shouldn’t be able to fire a weapon. There are things that we should not be using AI to do, and we collectively have to decide that we need public oversight so that all of this technology is not being created for the interests of a few against the well-being of the many.”

“I categorically oppose the use of AI to allow health insurance of any kind to second-guess decisions made by your doctor.”

“Peggy believes it’s time to ban insurance companies from using prior authorization processes for care. Too many Minnesotans have sat on the phone and begged their insurance company to cover a prescription medication, a treatment, or a surgery. A stranger behind a desk or an AI algorithm shouldn’t be able to deny you care your doctor prescribed.”

“Until recently, supporting Medicare was an issue that we all agreed on. In the Senate, Peggy will fight back against cuts to Medicare and Donald Trump and Health and Human Services Secretary Robert F. Kennedy Jr.’s plan to use AI for prior authorization to dictate what care seniors receive, as opposed to the doctors who prescribe it.”

“And prevent AI from coming between people and their doctors in response to the Trump Administration’s plan to launch a program where AI would decide on coverage and care for Medicare patients.”

“Stop AI from coming between people and their doctor. The Trump Administration is getting ready to launch a program to see how AI could deny coverage and care to people on Medicare – which would impact more than 350,000 Granite Staters. Doctors and nurses should be making decisions about health care, not computer algorithms.”

“And finally, I would ensure, again, in the very near term, that we prevent AI from ever making a decision about who gets coverage and who doesn’t.”

“Ahead of a candidate forum at the RiverWoods Retirement Community, Stefany Shaheen is calling for closing coverage gaps in Medicare and halting a Trump Administration plan to use AI to deny coverage and care to people on Medicare.”

“Prevent AI and insurance companies from making decisions that should be made by doctors.”

“Prevent AI from making decisions that should be made by doctors. The Trump Administration is getting ready to launch a program that would allow AI to deny coverage and care to people on Medicare – that would affect more than 350,000 Granite Staters. Doctors and nurses should be making decisions about health care, not computer algorithms.”

“Ohioans deserve a senator who will lower costs. That’s why, in the Senate, I’ll fine insurance companies for wrongly denying claims and make it illegal for drug companies to charge more in America than they do overseas for the same medicine.”

“It’s time to ban health insurance companies from denying the care your doctor says you need. And if they try to deny your claims, we’ll fine them.”

“SB 858 (Author: Wiener): Updates and increases penalties for health plans that violate state law in denying or delaying insurance coverage.”

“Peggy believes it’s time to ban insurance companies from using prior authorization processes for care. Too many Minnesotans have sat on the phone and begged their insurance company to cover a prescription medication, a treatment, or a surgery. A stranger behind a desk or an AI algorithm shouldn’t be able to deny you care your doctor prescribed.”

“Force insurance companies to cover mental health and addiction treatment the same way they cover physical health — extending California's landmark parity law to every American — and removing prior authorizations.”

“SB 159 (Author: Wiener): Expanding PrEP and PEP access. SB 159 is first-in-the-nation legislation that allows pharmacists to provide PrEP and PEP — two powerful anti-HIV preventatives — to people without a physician’s prescription. Far too few people who need PrEP are on it, due to various financial and logistical barriers, as well as continuing stigma. Communities of color and rural communities are particularly likely to lack access. One barrier is lack of access (or lack of timely access) to physicians, another is that some physicians are hostile to these HIV preventatives and resistant to prescribing it. By allowing people to go to their neighborhood pharmacy to access PrEP and PEP, without first having to find a physician and perhaps wait months for an appointment, SB 159 will dramatically expand where people can access PrEP and PEP and will make it much to gain that access. SB 159 also bans insurance prior authorizations for PrEP and PEP, which can delay obtaining them.”

“SB 159 (2019): Authorizes pharmacists to furnish pre- and post- exposure prophylaxis (PrEP and PEP) without a physician prescription and also prohibits insurance companies from requiring prior authorizations in order to obtain PrEP coverage.”

“Ban AI-based prior authorization. Automated denial systems are overriding physician judgment at scale, delaying or denying healthcare your doctor said you need. No algorithm should be able to deny care that a licensed physician has determined is necessary. Prior authorization decisions must be made by a licensed physician with full access to the patient’s record and subject to binding physician-to-physician review on appeal.”

“SB 238 (Author: Wiener; bill pending): Youth Mental Health Access Act. SB 238 removes barriers to youth accessing mental health treatments by requiring that any private insurance treatment denials be automatically referred to the state’s existing Independent Medical Review process.”

“The system prioritizes profit over patient care and prevention, leading to inefficiencies and dramatically higher costs. In today’s system, insurance companies deny first, forcing American healthcare providers to spend time fighting insurance for basic needs, like insulin or chemotherapy. People can’t access the care they need, or simply can’t afford it. This makes us sicker and shifts the burden of healthcare costs away from the insurance companies and onto the taxpayers.”