Health and Wellness
Companies that help insurance companies deny pre-authorization claims –
KFF survey found that roughly 6 in 10 insured adults have experienced problems while using their insurance. Issues include denied claims, network adequacy, pre-authorization delays and denials. As the investigation shows, this is just not a surprise. A hidden industry makes money by denying doctors’ payment requests, called prior authorizations.
According to a ProPublica investigation, one in every of the important thing participants on this scheme is Evernorth’s EviCore. A ProPublica investigation found that EviCore is owned by the big insurance company Cigna. The largest U.S. insurance companies employ EviCore and supply protection to 100 million consumers.
EviCore apparently uses a synthetic intelligence-supported algorithm that insurance industry insiders call “the shield.” The algorithm system will be customized, which ultimately results in more pre-authorization claim rejections.
What’s even weirder is that EviCore reportedly has some contracts that allow it to make more cash the more it cuts health care spending by insurance companies.
EviCore is just not alone. Another big player is Carelon Medical Benefits Management, a subsidiary of Elevance Health, formerly Anthem. Although the corporate has been accused in court of unlawfully denying legitimate insurance applications, it denies all allegations.
How companies respond
EviCore claims that the approval process ensures that the procedures are protected, obligatory and price-effective.
“We are improving the quality and safety of healthcare, and – by a happy coincidence – we are significantly reducing unnecessary costs,” said an EviCore doctor in the course of the company’s series of webinars.
But based on the investigation, EviCore’s approach is way more sinister than it suggests. EviCore reportedly guarantees a 3-to-1 return on investment, which implies your insurer can pay $3 less for medical care and other costs.
For some perspective, in 2021 in Arkansas, EviCore denied prior authorization requests almost 20% of the time. Medicare Advantage plans denied prior authorization requests about 7% of the time in 2022, based on a ProPublica evaluation of knowledge.
A Cigna spokesperson said on behalf of EviCore: “Simply put, EviCore uses the latest evidence-based medicine to ensure patients get the care they need and avoid services they don’t need.”
The spokesperson added that the corporate uses algorithms in some clinical programs “only to expedite the approval of appropriate care and reduce administrative burdens on healthcare providers.”
Health and Wellness
“Get Lifted” by John Legend (twentieth Anniversary Edition) [Interview] – Essence
Photo credit: Danny Clinch
When John Legend unveiled his debut album in 2004, he couldn’t have predicted the extraordinary legacy it could construct over the following 20 years. Now, with the discharge the singer returns to the project that launched his profession and redefined the boundaries of R&B, hip-hop and neo-soul. Available now, the digital Deluxe Edition offers fans a refreshed tackle timeless classics with remixes, rare tracks and collaborations that bring latest energy to the music.
The twentieth Anniversary Edition includes 11 bonus tracks, including remixes from iconic artists equivalent to Tems, Killer Mike, Lil Wayne, Simi and Black Thought. Two previously unreleased songs – “Do What I Gotta Do” and “Just In Time” – offer fans an intimate look into Legend’s creative process during this era. The album’s revival doesn’t end there; will even be available as 3LP vinyl in 2025, and all copies are signed by Legend.
Reflecting on the challenges of making an original album, the award-winning artist recalled the struggles of an aspiring artist trying to search out their sound. “I wrote a lot of this album when I wasn’t signed, so the big challenge was just figuring out what would work to give me a chance to get the music out there,” he explains. . “I’ve been trying to get a record deal for over five years, but record labels were turning me down both left and right.”
It was only when Kanye West took a likelihood on Legend and signed a contract with GOOD Music that all the pieces began to alter. Working with West and touring together opened doors for the University of Pennsylvania graduate. That same yr, he signed a record take care of Columbia and was able to hit the shelves. The album’s breakout single “Ordinary people” became the anthem that defined Legend’s artistry. “When it finally came out and made it work the way it did, especially with my second single, it was really beautiful to see it start to connect and connect with people,” she tells ESSENCE.
On the occasion of the anniversary edition, Legend collaborated with artists who provided a refreshing atmosphere to Legend’s debut – but remixes aren’t just repetitions of original songs. “I’m a fan of every artist we asked to be a part of the remix,” says Legend. “They have new beats, new energy, new vibes and of course new guest artists. It really brought a fresh perspective to music and excited me to reconnect with music.”
was a breakthrough album for the Ohio-born artist, combining multiple genres in a timeless and groundbreaking way. “I felt like it happened when neo-soul was already at its peak, so in a way it was almost like my reaction to neo-soul,” Legend reflects. “We also combine hip hop and gospel and create something fresh.” Legend’s commitment to songwriting is a thread that runs deep through his work then and now.
The physical format of music, especially upcoming vinyl releases, also plays a big role in maintaining the impact of the unique album. “There will always be people who want to hold something, read the sleeve notes, and play vinyl on their record players at home,” Legend states. “Especially when you’re celebrating an anniversary like this, it’s nice to have a commemorative thing that you can keep. This album means something to people because they remember 20 years ago when they started listening to it and what it meant to them then.”
Rekindling the magic of a pioneering debut, it also stands as a testament to Legend’s enduring craftsmanship. The album stays a masterclass in musical storytelling, connecting generations of fans and proving that great music, like great artists, only gets higher with time.
Health and Wellness
US communities phase out fluoride use in public drinking water
There is a battle raging in American cities over whether to proceed using fluoride in water.
This is a process generally known as fluoridation that began around 1945. According to to the American Cancer Society became popular across the country after scientists noticed that individuals living in water with higher concentrations of fluoride had less tooth decay.
In 1962, the U.S. Public Health Service (PHS) advisable adding fluoride to public drinking water supplies to forestall tooth decay. The American Cancer Society estimates that fluoride is currently used in public drinking water supplied to roughly three in 4 Americans.
However, opponents have been warning for years that fluoride in drinking water is unsafe to devour. One of the organizations leading this initiative is Fluoride Action Network (FAN). The organization, whose mission is to lift awareness of what it claims is the “toxicity of fluoride compounds,” says many of the world’s developed countries don’t use fluoride in drinking water at the identical levels as America, or in any respect.
The organization says yes it helped over 500 communities successfully reject fluoridation, and there could also be more.
Federal leaders have gotten increasingly vocal in their support for ending the use of fluoride
While FAN says communities have rejected fluoridation for the past few a long time and the method has stalled in consequence, the fight has been thrust into the highlight over the past few months.
First, the National Toxicology Program, a federal agency throughout the Department of Health and Human Services, reported with “moderate certainty” that there may be an association between communities with higher levels of fluoride exposure and lower IQ in children. According to the Associated Press, these communities use greater than twice the advisable limit.
A month later, a federal judge apparently ordered the U.S. Environmental Protection Agency (EPA) to further regulate fluoride in drinking water because higher levels could affect children.
Robert F. Kennedy, nominated by President-elect Donald Trump to direct the Department of Health and Human Services, announced an end to fluoridation.
Health and Wellness
WATCH: Cynthia Erivo on the importance of being a sister – Essence
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