fbpx Skip to content

Policy

Babu Healthcare Advocacy firm believes that creating change within the healthcare delivery system involves coming together with local communities, healthcare providers, policy makers, regulatory bodies, patients, their advocates and healthcare insurance companies.

Together as a collective we are better able to enhance our strength and ensure patients nationwide have access to quality healthcare.  

Welcome to our Policy page. This is a space where we share policy information, news and healthcare resources. 

Policy Resources

Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials

When beneficiaries and providers appealed preauthorization and payment denials, Medicare Advantage Organizations (MAOs) overturned 75 percent of their own denials during 2014–16, overturning approximately 216,000 denials each year. During the same period, independent reviewers at higher levels of the appeals process overturned additional denials in favor of beneficiaries and providers. The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided.

DMHC Fines 12 Health Plans $1.9 Million for Improperly Denying Care to Enrollees

The California Department of Managed Health Care (DMHC) announced enforcement action against a dozen health plans, including fines totaling $1.9 million, for lack of oversight of a contracted medical group which led to improper denials and delays of enrollees’ care.

Jury delivers $25.5 million 'statement' to Aetna to change its ways

An Oklahoma jury awarded $25.5 million to the family of a cancer patient denied coverage by Aetna, with jurors saying that the insurer acted "recklessly" and that the verdict was meant as a message for Aetna to change its ways.

Receive the latest news

Subscribe To Our Weekly Newsletter

Get notified about new articles