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Healthcare Policy and Opinion

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EDITORS CHOICE

“Investigational” Is Payer Code for “Coverage Denied”

Gil Bashe, Medika Life Editor -
Outside the pandemic, “investigational” remains payer code for denying reimbursement. In the case of treatment for chronic conditions, even FDA-approved digital-health and connected devices languish on waitlists for formulary inclusion.

We Know the Health Ecosystem is Fragmented, Resulting in Rising Costs and Poorer Patient Outcomes, But What Are We Doing About It?

Gil Bashe, Medika Life Editor -
As We Enter the “Post-Fragmentation” Period, Health System Kinetics Points Us Toward Solutions

‘They Won’t Help Me’: Sickest Patients Face Insurance Denials Despite Policy Fixes

Medika Life -
In 2023, Sheldon Ekirch was diagnosed with small fiber neuropathy, which makes her limbs and muscles feel as if they’re on fire. Specialists recommended a series of infusions to ease her pain, but her insurer refused to pay for the expensive treatment, which it says is “not considered medically necessary.”

Does CBD Affect Your Cognition?

Michael Hunter, MD -
VE SOME NEWS FOR you regarding brain health: Driving ability and cognition are not affected by cannabidiol (CBD), even at very high doses.

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