Medical Necessity

There are legal safeguards to protect patients from big bills like out-of-network air-ambulance rides. But insurers may not pay if they decide the ride wasn't medically necessary.

Demand for help monitoring patients' vital signs remotely has taken off since a Medicare change in 2019. Dozens of companies now push the service to help overburdened primary care doctors — and as a revenue stream. But some policy experts say its growth has outpaced oversight and evidence of effectiveness.

California's taxpayer-funded health care program will cover the cost for illegal immigrants' sex change surgeries, according to a memo circulated from 2022.

Groups lament stress to enrollees and billions in hospital losses from coverage delays, denials

Former Proud Boys leader Enrique Tarrio praised Rep. Jim Jordan and blasted the Department of Justice during a jailhouse call with supporters and journalists.The jailed militant echoed the themes of Jordan's congressional hearings into the supposed "weaponization" of government institutions and urge...

Mounting news reports since the U.S. Supreme Court overturned Roe v. Wade last year have detailed the experiences of pregnant people who have been denied lifesaving abortion care, and in the case of one woman in Oklahoma last month, the state's abortion ban effectively barred her from receiving canc...

The ban would prohibit all abortions after six weeks of pregnancy, before most women know they are pregnant.

CMS seeks to ensure people in Advantage plans have the same access to necessary care as those in traditional Medicare. The agency also cracked down on Medicare Advantage marketing for "sowing confusion."

The FDA approved mifepristone more than 20 years ago.

People who smoke marijuana were more likely to have certain types of lung damage than people who smoked cigarettes, according to a new study.

West Virginia Gov. Jim Justice (R) on Friday signed into law a bill banning almost all abortions save for instances of rape, incest, or medical necessity, CNN reports. The ban, approved by the West Virginia Legislature earlier this week, will take effect immediately, with criminal penalties to begin in 90 days, CNN notes. "I've done exactly what I said I would do — I've signed it," Justice said of the legislation…

Citing high workloads and long waits for patients, the union representing 2,000 Kaiser NorCal mental health works announced plans to strike.

Jessica Winter writes about the uncertainty among medical-care providers following the U.S. Supreme Court's ruling that repeals the national right to abortion, with many physicians expressing uncertainty about what procedures may still be legal or for how long.

The U.S. Supreme Court on Monday made it harder for prosecutors to win convictions of doctors accused of running "pill mills" and excessively prescribing...

As abortion access shrinks in the U.S., more people will likely turn to medication abortion (also known as a medical abortion or abortion pills). Here's what to know.

A federal law exists that could protect women having life-threatening pregnancy complications—but only if the Biden administration decides to use it.

Doctors warn women's lives would be endangered and maternal deaths could increase.

New data from the Medical Group Management Association show that physicians are getting no relief from regulatory woes.

This is a MedPage Today story. When Michael Adams was researching health insurance options in 2023, he had one very specific requirement: coverage for prosthetic limbs. Adams, 51, lost his right leg to cancer 40 years ago, and he has worn out more legs than he can count. He picked a gold plan on the Colorado health insurance marketplace that covered prosthetics, including microprocessor-controlled knees like the…

The Affordable Care Act reined in many of the worst abuses of the health insurance industry, like denying people for pre-existing conditions or for meeting a lifetime coverage maximum — but it remains an industry where patients can be denied critical care for nonsensical reasons — and horror stories...