Podcasts about prior authorization

In this episode of Disruption/Interruption, host KJ interviews Dr. Paola Ballester, CEO and Co-founder of EasyPA, about the broken state of prior authorizations in healthcare. Dr. Ballester shares her journey from pediatrician to tech founder, the real-world impact of administrative burdens on patients and clinicians, and how her AI-driven platform is streamlining processes to put patient care back at the center. Key Takeaways: The Real Cost of Prior Authorizations [2:05] – Administrative hurdles in healthcare lead to denied claims, lost revenue, and wasted time, forcing clinicians to choose between paperwork and patient care. Empathy Drives Disruption [4:35] – Dr. Ballester’s deep empathy for patients and providers inspired her to create a solution that addresses the root frustrations in the system. AI as a Force for Good [27:05] – EasyPA’s AI platform modernizes prior authorizations, making them 10x faster and giving clinicians more time with patients, not paperwork. Systemic Change is Possible [36:45] – With new technology, regulatory mandates, and a focus on patient-centered care, the healthcare system can move beyond outdated, inefficient processes. Quote of the Show [19:40]:"The assumption that physicians need to prove on a per case basis that their intent is anything other than to provide direct patient care based on evidence-based standards is wild." - Paola Ballester Join our Anti-PR newsletter where we’re keeping a watchful and clever eye on PR trends, PR fails, and interesting news in tech so you don't have to. You're welcome. Want PR that actually matters? Get 30 minutes of expert advice in a fast-paced, zero-nonsense session from Karla Jo Helms, a veteran Crisis PR and Anti-PR Strategist who knows how to tell your story in the best possible light and get the exposure you need to disrupt your industry. Click here to book your call: https://info.jotopr.com/free-anti-pr-eval Ways to connect with Dr. Paola Ballester: LinkedIn: https://www.linkedin.com/in/paola-ballester-md-7738a9a8/ Company websites: easypa.ai How to get more Disruption/Interruption: Amazon Music - https://music.amazon.com/podcasts/eccda84d-4d5b-4c52-ba54-7fd8af3cbe87/disruption-interruption Apple Podcast - https://podcasts.apple.com/us/podcast/disruption-interruption/id1581985755 Spotify - https://open.spotify.com/show/6yGSwcSp8J354awJkCmJlDSee omnystudio.com/listener for privacy information.

Dr. Donna Milavetz, chief medical officer for Regence, talks about how prior authorization helps make health care safer, more effective and more affordable, and the pain points that the industry is committed to improving.

In this episode, Molly Gamble sits down with Dr. Shiv Rao, Founder and CEO of Abridge, to discuss the company's newest breakthrough: a real-time prior authorization solution launched with Highmark and Allegheny Health Network. Dr. Rao shares why this milestone marks a shift from passive to active AI support, how Abridge is reducing clerical burden for clinicians, and what it means for patients, payers, and providers navigating prior authorization challenges.

This episode features David Byrd, Senior Vice President at Infinx, as he walks through a proven four-step prior authorization process that helps reduce denials, accelerate turnaround times, and improve patient access. Listeners will hear how technology and human expertise combine to deliver scalable results across specialties while supporting better patient and staff experiences.

Dr. Jeremy Friese knows medicine from both sides. A practicing radiologist and technology executive, he's seen firsthand how administrative burden undermines care. In this episode of NEJM AI Grand Rounds, he walks through the origins of prior authorization, explains why he believes artificial intelligence can close the gap between patients and payers, and argues that real reform means showing your work—just like in math class. At Humata, he's combining human oversight, LLMs, and interoperability to try to fix a broken system. For clinicians overwhelmed by back-office complexity, this conversation offers both urgency and optimism. Transcript.

From Prior Authorization Chaos to Clear AI Orchestration Prior authorization isn't just broken — it's unsynchronized. On this episode, Evan Martin, VP of Revenue Cycle Management at ZoomCare Inc as well as Host and Producer of The Wilshire's IT RevCast, shares what happens when real-time care delivery meets a fragmented, rule-heavy prior auth system that can't keep up. With just one authorization specialist covering 50 clinics, Evan paints a clear picture: today's healthcare moves fast, but prior auth is still stumbling through a maze of plan-specific rules, outdated workflows, and underperforming automation tools. We explore how even routine imaging, meds, and mental health services become tangled in conflicting payer policies and benefit silos. Evan breaks down the bottlenecks, the firefighting, and the policy blind spots — plus why simply layering automation on top won't fix it. The real opportunity? An orchestrated model powered by agentic AI triages, retrieves, and routes the right information to the right place — so human teams can actually focus on patient care. This isn't theory. It's the lived complexity of treating patients while waiting for permission — and what the future could look like if we finally got the process in tune. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Navaneeth Nair, Chief Product Officer, and Jonathan Aguiar, Senior Solutions Engineer, share how embedding AI driven prior authorization directly into the EHR keeps providers in their familiar workflow while giving supervisors and leadership complete operational visibility. Discover how digital and human agents work together behind the scenes to accelerate approvals, prevent denials, and adapt to changing payer requirements.

CMS is rolling out prior authorization for traditional Medicare. This Office Hours panel breaks down what the WISeR model means for providers, how AI is involved, and what steps to take now—whether you're in a test state or watching for what's next. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Evan Martin joins us to break down the daily chaos of managing prior authorizations in a real-time care model. From retro auths to plan-specific rules and underwhelming automation, Evan reveals why today's processes are out of sync — and what an agentic AI solution could look like to finally orchestrate it all.Brought to you by www.infinx.com

What happens when managed care surges in IVF, reimbursements drop, and physicians are expected to do more work for less?Dr. Ravi Gada and Manish Chhadua are back on the show, and they don't hold back. Dr. Gada is a partner at one of the largest independently owned practices in the United States and he and Manish co-own and operate a firm called CloudRx, In this episode, they dig into:What 70 fertility centers are doing to slash administrative costs from prior authorization chaos How medication side savings are shifting into the medical services side (and what that means for practices)Changes in the payer market and insurer preferences you need to know aboutWhy Organon and Follistim have gained so much market share in the past 5–7 yearsWhy academic fertility center ratings are shockingly low (and what private practices can learn from that)

Faxed orders, scanned attachments, and inbox folders shouldn't be the reason prior authorizations are delayed. Yet for many radiology groups, that's still the case. Manual document capture creates friction at the front of the process—forcing staff to rename, sort, and route incoming faxes before a prior auth can even begin. In this episode, we explore how automating document capture accelerates the entire prior authorization workflow. From identifying STAT orders to extracting key order details and triggering auth submissions, we'll walk through how imaging centers are using AI-driven tools to minimize lag, reduce errors, and scale operations without burning out staff. Joining us is Charulata Nevatia, a healthcare product leader with deep experience in workflow automation. She'll share what high-performing radiology groups are doing differently and what steps you can take to modernize intake and boost auth readiness. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

In this episode of AUA Inside Tract, Dr. Kevin Koo, endourologist and chair of the AUA Federal Advocacy Committee, is joined by Dr. Grace Hyun, pediatric urologist and AUAPAC board member, to unpack one of the most pressing issues in urologic practice today: prior authorization. Using data from the AUA Census, they explore how increasing administrative burdens are delaying care, adding unnecessary costs and contributing to physician burnout. With over half of urologists reporting that prior authorization significantly affects patient outcomes, this episode highlights the real-world impact of policy on daily practice. Take the AUA Census: auanet.org/TakeCensus Support the AUAPAC: myauapac.org

Welcome to 'AI Lawyer Talking Tech,' the podcast that explores the profound transformation occurring within the legal world. Artificial intelligence is no longer just a futuristic concept; it is actively reimagining legal services, from sophisticated tools capable of managing multi-step tasks to AI-powered law firms redefining efficiency for private market investors. While firms are quickly integrating AI into workflows for everything from drafting to internal inquiries and even merger support, the technology still faces significant challenges, including the crucial need for AI to automatically understand user context, the risk of AI 'hallucinations' fabricating information, and complex issues surrounding data privacy, bias, and legal liability. Regulatory bodies worldwide are also addressing these complexities, with new action plans and comprehensive laws shaping the responsible development and deployment of AI. Today, we delve into how legal professionals and policymakers are shaping the future of law in this rapidly evolving AI era.Context is king when it comes to AI24 Jul 2025City A.M.Pinsent Masons: Pinsent Masons and ContractPodAi forge strategic partnership to expand AI-powered legal services24 Jul 2025ContractPodAiInitial Reactions to the White House AI Action Plan: Five Things U.S. Businesses Should Know24 Jul 2025Debevoise Data BlogLexisNexis unveils Protégé AI assistant to boost UK legal work23 Jul 2025IT Brief UKContractPodAi Expands Global Team to Power Next Phase of Legal AI Growth23 Jul 2025Legal ReaderIs Your AI Scribe HIPAA-Compliant?23 Jul 2025Health LeadersPartner Who Wrote About AI Ethics, Fired For Citing Fake AI Cases23 Jul 2025Above The LawFrom Data to Decisions: Navigating Privacy and Litigation Risks in the AI Era23 Jul 2025JD SupraReflections on the CALL/ACBD Conference23 Jul 2025In Custodia LegisAI isn't just entering law offices—it's challenging the entire legal playbook23 Jul 2025Yahoo! NewsLitera introduces Lito: The next evolution of agentic AI in legal23 Jul 2025Legal FuturesQ&A with Jen Berrent, Founder and CEO of Covenant23 Jul 2025CityBiz.coNew LSNTAP tools help legal services organizations use data to achieve greater impact23 Jul 2025Florida Bar NewsWhen AI makes mistakes in the courtroom23 Jul 2025DNyuzGetty Images vs Stability AI: The UK court battle that could reshape AI and copyright law23 Jul 2025Tech MonitorDebevoise's AI Subscription Platform (STAAR), Which Helps Clients Fast-Track Their AI Adoption, Featured in Law36023 Jul 2025Debevoise Data BlogThe Attribution Problem: Navigating AI Liability Gaps in Autonomous Systems23 Jul 2025Legaltech on MediumOregon Strengthens Geolocation Data Privacy and Children's Personal Data Protections, Adding to Compliance for Data Brokers and Others23 Jul 2025ProskauerWISeR Model Will Test the Use of Artificial Intelligence for Prior Authorization in Medicare: Key Considerations for Health Care Providers and Suppliers23 Jul 2025Mintz LevinEU & UK AI Round-up – July 202523 Jul 2025King & SpaldingThink While You Are Using AI Coding23 Jul 2025Baker Donelson Bearman Caldwell & Berkowitz PCTexas Joins Growing State-by-State AI Regulation in Enacting Comprehensive AI System Law23 Jul 2025BeneschPodcast - Tips for Maintaining FTC Compliance When Using AI23 Jul 2025Holland & KnightSweepstakes Casino Lawsuits Surge in Alabama22 Jul 2025Daily Caller

CMS is rolling out prior authorization for traditional Medicare. This Revenue Cycle Optimized panel breaks down what the WISeR model means for providers, how AI is involved, and what steps to take now—whether you're in a test state or watching for what's next.Brought to you by www.infinx.com

As CMS rolls out the WISeR model, prior authorization is expanding into traditional Medicare for the first time. In this internal Infinx discussion, we explore how providers are beginning to respond, where the opportunities lie, and why proactive preparation is key.

Understanding the New Medicare Preauthorization Pilot: What Agents Need to KnowIf you're an insurance agent, advisor, or just someone who loves to stay on top of Medicare changes, episode 85 of the Insurance Business Babes podcast is a must-listen. Hosts Joanna Wyckoff and Kathe Kline dive deep into Medicare's new pilot program for prior authorizations on certain Part B services—sparking lots of questions (and a bit of anxiety) among agents and clients alike. Here's a summary and further commentary on what you need to know.What's Changing and Where?This new prior authorization program doesn't signal an immediate, nationwide overhaul; for now, it's a six-year pilot launching in 2026, affecting just six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Importantly, it targets only specific services, not everything under Part B. As Joanna reassured, “It's not a complete change across the board,” so there's no need to panic—yet".Which Services Are Included?There's a preliminary list of 17 service categories that will require prior authorization, including procedures like knee arthroscopy, spinal fusion, epidural steroid injections, implants for sleep apnea, and expensive wound care products. Many of these (like knee scopes and advanced wound care) have been flagged for possible overuse and abuse in the past.Kathe pointed out how this pilot likely aims to rein in unnecessary spending, similar to how the system already handles powered wheelchairs or certain prosthetics nationwide.Impacts for Agents and ClientsJoanna stressed the need for communication: If you have Med Supp clients in the affected states, you should proactively reach out to prepare them—before they hear from a competitor. It's crucial to clarify that Med Supp plans still can't require their own prior authorizations; the requirement comes from Medicare itself.For now, most “normal” Part B services won't require pre-auth, and providers demonstrating “clean requests” may even earn exemptions. AI programs will help process authorizations, but final decisions should still involve a human touch.Looking AheadThough limited for now, both hosts agreed agents should keep a close eye on this pilot. The landscape could shift significantly if results push Medicare to roll out prior authorizations nationwide. Stay informed, keep your clients prepared, and remember—clear, early communication keeps your relationships strong.This episode is sponsored by ⁠CertifiedMedicareAgents.com⁠. Use the coupon code BABES2024 for a free lifetime BRONZE membership.

If your prior auths can't start until someone opens a fax, this episode is for you. Learn how automating document capture is streamlining radiology workflows and speeding up approvals from day one.Brought to you by www.infinx.com

Major U.S. health insurers have pledged to reform prior authorization processes, aiming to reduce delays and administrative burdens. Join us as we explore the details of this announcement, its historical context, and what it means for providers and patients moving forward.Brought to you by www.infinx.com

Welcome to another episode of the Heartland Daily Podcast, where Ann Marie Sheber and healthcare economist Devon Herrick unpack this week's biggest developments in health policy:

Welcome to another episode of the Heartland Daily Podcast, where Ann Marie Sheber and healthcare economist Devon Herrick unpack this week's biggest developments in health policy:

“Delay, Deny . . .”— Feds take aim at prior authorizations that block patients' access to care, surgeries, drugs they need; Electrodiagnostic testing with computers—does it add up for diagnosis? Are there non-surgical options for goiters? Chili peppers confer heart, cancer, longevity benefits; Will stem cells deliver a cure for insulin-dependent diabetics? Vitamin C reprograms skin cells to reverse age-related thinning.

In the Medicare Advantage Minute we learn how MA plans use prior authorization requirements to help balance the books. This at the expense of patients who are in need of medical treatment for the best opportunity to regain health! Nebraska is taking the lead in the war to make MA plans better for their members. In the Your Medicare Benefits segment we learn how Medicare is likely to cover lymphedema compression treatment items. Do you like to get stabbed? We cover a list of vaccinations recommended for adults. Finally, an advisor known only as "Rusty" takes a question from a couple who are shocked to have been caught by the "Success Penalty" known as IRMAA. IRMAA casts a wide net but there is an appeal process that has shown success in the past. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

This week in the Breakroom, Lynn Nonnemaker joins Maddie News to discuss the recent announcement by health insurers to streamline the prior authorization process. Read more in our Regs and Eggs blog post.

Headlines:  – Welcome to Mo News (02:00) – NYC Election Results (04:00) – Cease-Fire Takes Hold After Trump Rebukes Israel and Iran (10:00) – Debate Over How Much Strike Set Back Iran's Nuclear Program (14:00) – Kennedy Says Health Insurers Promise to Change Prior Authorization Process (34:30) – Kennedy Denies Lying to Sen. Bill Cassidy About Vaccine Panel (38:20) – Choosing ‘Buy Now, Pay Later' at Checkout Will Now Factor Into Your Credit Score (42:00) – Amazon Bringing Faster Delivery to Thousands of Small Towns and Cities (44:00) – On This Day In History (41:20) Thanks To Our Sponsors: – ZocDoc - Book Top-Rated Doctors  – LMNT - Free Sample Pack with any LMNT drink mix purchase – Industrious - Coworking office. 30% off day pass – Athletic Greens – AG1 Powder + 1 year of free Vitamin D & 5 free travel packs – Incogni - 60% off an annual plan| Promo Code: MONEWS – Saily - 15% off any data plan | Promo Code: MONEWS

This episode features Laura Dyrda, Vice President and Editor-in-Chief at Becker's Healthcare, and Alan Condon, Editor-in-Chief at Becker's Healthcare. The conversation covers the latest reforms in prior authorization, hospital financial pressures, rural healthcare challenges, and how smart technologies like AI and ambient listening are shaping the future of patient access and operational efficiency.

Genevieve Wood, Senior Advisor at The Heritage Foundation joins to talk about President Trump and Iran

Listen in as Joseph Kim, MD, MPH, MBA; Manish Shah, MD; Martha Grugel, MA, discuss how they manage the prior authorization process for antiobesity agents to improve the quality of their care delivery, including:The information to collect during patient visitsThe available resources to help you submit prior authorizationsThe supporting documents that are often necessary to accompany prior authorizationsHow to address denials and appealsWhen to access manufacturer-based or foundation-based financial assistancePresentersJoseph Kim, MD, MPH, MBAPresidentQ Synthesis, LLCNewtown, PennsylvaniaManish Shah, MDClinical Associate Faculty MS1 PreceptorUniversity of Florida College of MedicineGainesville, FloridaMartha Grugel, MAMedical AssistantWesley Chapel, FloridaLink to full program: https://bit.ly/45P0v8z

The Big Unlock Podcast · Transforming Prior Authorization with AI – Podcast with Siva Namasivayam He shares how AI is being applied to reduce administrative delays, including the use of generative AI to summarize clinical data and intelligent agents to assist with scheduling and information retrieval processes. The conversation also touches on enabling real-time approvals for a majority of cases, designing algorithms informed by physician input, and navigating the shift to remote work. The discussion offers insight into how technology can address systemic inefficiencies while maintaining clinical oversight. Take a listen.

Months into the 2025 state legislative sessions, how are the key issues of prior authorization, scope of practice, and physician wellness playing out? What themes are emerging and how are they different than those of previous years?  Led by AMA President Dr. Bobby Mukkamala, this panel of AMA Advocacy Resource Center attorneys talks about how the AMA is working with national, state and specialty medical societies to address these key legislative priorities.     ⭐⭐⭐⭐⭐

The Medicare Advantage Minute segment once again illustrates the fact that very few appeals were filed by MA victims of prior authorization refusals. However, the majority of those appeals resulted in reversals of the denials! In "Your Medicare Benefits 2025" we learn how Medicare covers insulin, including the newly created $35 monthly out-of-pocket limit! Moments before recording time a plea for assistance arrived from a victim of the barrage of MA plan brutality that happens to everyone who turns age 65. After hearing a radio interview he decided to emerge from hiding and take a chance on Medicare for the Lazy Man. Finally, How can one appeal a Part D lifetime late enrollment penalty? Just listen to find out! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

What policies does the American Medical Association support? What does the American Medical Association fight for? What are the biggest struggles doctors face today? American Medical Association CXO Todd Unger hosts.

How do you know if something needs prior authorization? Why does prior authorization take so long? What is electronic prior authorization? Discussing how to speed up prior authorization process using informatics in health care, HL7 and FHIR, computerized physician order entry, and more with Viet Nguyen, MD, chief standards implementation officer for HL7 International. American Medical Association CXO Todd Unger hosts.

Glidian, now part of the Infinx family, brings cutting-edge automation to the prior authorization process, helping providers significantly reduce denials and improve cash flow. In this episode, co-founder Ashish Dua shares how Glidian's technology simplifies payer interactions, boosts staff efficiency, and expands patient access across labs, radiology, and emerging care verticals.

In this episode of Breaking Health, guest host Payal Agrawal Divakaran, partner at .406 Ventures, speaks with Jeremy Friese, CEO of Humata Health, about prior authorization and how Humata is helping from “both sides of the fax machine.” Friese also discusses his thoughts on the future of AI adoption, how the regulatory landscape looks, and more. He also shares what the transition between physician to entrepreneur was like, what it's like to found and grow companies, and how to select the right VC partners. Links from this episode:  HealthEdge  .406 Ventures Humata Health  

Why is relating to patients important? How do you treat brain cancer? What is brain cancer treatment like? What are the benefits of understanding patient experience? AMA President-elect Bobby Mukkamala, MD, shares his personal journey from brain tumor diagnosis through recovery. Dr. Mukkamala discusses how being a patient reshaped his views on health care, the challenges of understanding a cancer diagnosis, the importance of family support—and how these experiences align with AMA priorities like prior authorization reform and addressing physician shortages. American Medical Association CXO Todd Unger hosts.

“We exist to solve prior authorization so patients can get the care they deserve,” says Dr. Jeremy Friese, founder and CEO of Humata Health. Friese joins Bloomberg Intelligence health-care analyst Jonathan Palmer to discuss how Humata’s AI-driven technology is transforming one of health care’s most notorious administrative headaches. They cover how Humata connects deeply into medical records, helps both providers and payers streamline approvals and is expanding into specialty pharmacy. Friese also shares his journey from Mayo Clinic radiologist to serial entrepreneur — and why he believes solving back-office burdens can unlock better patient care.See omnystudio.com/listener for privacy information.

What are the outcomes of prior authorization patients? How do insurance companies use AI? How does prior authorization work? Who is responsible for getting pre authorization? AMA President Bruce A. Scott, MD, shares key takeaways from the AMA's recent prior auth survey, discusses physicians' concerns about prior authorization in healthcare, how prior authorization negatively impacts employers by reducing employee health and productivity. American Medical Association CXO Todd Unger hosts.

Michael chats with Dr. Colin Banas, Chief Medical Officer at DrFirst. Together, they discuss automating and modernizing prior authorization workflows to speed access to critical drugs; challenges and opportunities in how providers, payers, and pharmacies share medication data and orchestrate prescription workflows across different systems; and advances in AI that can make a real difference for clinicians in practical, measurable ways.

Despite advancements in healthcare technology, prior authorization still relies on fax machines, phone calls, and manual data entry. In this episode, Jennifer Glockzin breaks down the daily challenges providers face with TPAs, intent-to-deny notices, and unaffiliated provider referrals—revealing where automation can finally bridge the gaps in patient access and revenue cycle management.

In this episode, Dr. Jeremy Friese, Founder and CEO of Humata Health, joins the podcast to discuss how his company is tackling the complex challenges of prior authorization through AI-driven solutions. He shares insights on the evolving healthcare landscape, the role of technology in reducing administrative burdens, and his advice for entrepreneurs looking to drive meaningful change in the industry.

Montanans could face fewer hurdles getting their insurance to cover medications and treatments.

Discover how AI and automation are transforming workflow optimization for orthopedic imaging centers. In this episode, Samantha Towler, Ancillary Patient Services Manager from Tennessee Orthopedic Alliance shares insights on leveraging technology to streamline prior authorization, reduce administrative burden, and improve operational efficiency in imaging workflows.

Governor Mike Braun is tasking his wife, First Lady Maureen Braun, with keeping Indiana's Dolly Parton Imagination Library program alive. A bill that would have made street camping illegal died in the Indiana House. The Indiana Senate approved a stripped down version of a prior authorization reform bill Thursday. Governor Mike Braun says he'll veto major property tax reform legislation if it doesn't "improve" as the session continues. Want to go deeper on the stories you hear on WFYI News Now? Visit wfyi.org/news and follow us on social media to get comprehensive analysis and local news daily. Subscribe to WFYI News Now wherever you get your podcasts. WFYI News Now is produced by Drew Daudelin, Zach Bundy and Abriana Herron, with support from News Director Sarah Neal-Estes.

In this episode of RCM Insights, we explore how GenAI Agents and automation are transforming prior authorization. Jason Adams, President of Ni2, and Navaneeth Nair, Chief Product Officer at Infinx, reveal how providers can use technology to stay ahead as payers scale AI-driven processes.

Who is responsible for getting pre authorization? How can pharmacists help doctors? What can the technician do to help expedite prior authorization? Our guests from Geisinger Health System are Kristen Kruszewski, director of pharmacy strategy, Seth Gazes, associate vice president of pharmacy strategy and planning, and Jerry Greskovic, vice president of ambulatory pharmacy services. American Medical Association CXO Todd Unger hosts.

In this episode of Healthcare Americana, host Christopher Habig speaks with Julie Baak, a practice manager at the Arthritis Center in St. Louis, about the challenges of patient access to infusion therapy and the manipulative practices of insurance companies. Julie shares her experiences managing a large number of infusion patients and the burdens imposed by insurance companies and pharmacy benefit managers. She discusses the role of social media in advocating for patients and how independent clinics can take back control of healthcare. The conversation highlights the need for reform in the healthcare system and the importance of patient-centered care.More on Freedom Healthworks & FreedomDocSubscribe at https://healthcareamericana.com/More on Julie Baak & STL Arthritis CenterFollow Healthcare Americana: Instagram & LinkedIN

Ankit Jain, CEO and cofounder of Infinitus Systems, Inc, joins Julie Yoo, a16z Bio + Health general partner, to discuss Infinitus's work in solving one of healthcare's most pressing challenges: workforce shortages. Leveraging LLMs and AI voice agents, Infinitus automates repetitive tasks, such as benefits verification and prior authorization, freeing up human talent for higher-value roles. Ankit reflects on the company's journey—from early proof-of-concept calls to scaling over five million patient-centric interactions—and shares their approach to mitigating the risks of AI errors through layered guardrails. More in "The Opportunity for Healthcare in a Post-LLM World":Super Staffing in Healthcare with Munjal ShahTransforming Clinical Trials with Alexander Saint-AmandPlus:Learn more about a16z Bio+HealthLearn more about & Subscribe to Raising HealthFind a16z Bio+Health on LinkedInFind a16z Bio+Health on X

The death of UnitedHealthcare's CEO has reignited backlash against health insurance practices, particularly prior authorization rules. This episode explores the parallels between today's outrage and the late 1990s backlash. Archelle sits down with Dr. Lee Newcomer, a fellow former Chief Medical Officer at UnitedHealthcare during that era, to share their unique insights. Together, they examine the pros and cons of prior authorization policies and discuss the urgent need for reforms to enhance access to medical care and restore public trust in the healthcare system. Key Takeaways: A Recipe for Navigating Your Prior Authorization Step 1: Have 5-7 days of patience. Step 2: After 5-7 days, call your doctor's and verify that the prior authorization was submitted. Make sure all the info is correct. Step 3: Call customer service and ask for the status of the request. If they don't have an answer, get a commitment on when they will follow up. Mention your intention to contact the Attorney General's Office Step 4: Escalate if there is no follow up within the time promised. Options (you can do all 3) ·     Call the Health Insurance Company CEO and request a referral to the Expedited Appeal Unit ·     Contact the Human Resources Department of your employer ·     Submit a complaint to the Attorney General's office in your state. Here's a link for the AG in each state: https://projects.propublica.org/claimfile/   Don't Forget: Keep your calm and be rationale. You'll get more accomplished that way. If your doctor believes that the medical test or procedure you need is urgent or emergent….don't wait for the prior authorization. Get the medical care you need and if its denied, you can appeal it later. Links: Attorney General Offices in each state State: https://projects.propublica.org/claimfile/ Connect with Archelle ArcHealth Newsletter: https://www.archellemd.com/newsletter Email: SpeakUpForYourHealth@gmail.com Instagram:  https://instagram.com/speakupforyourhealth Facebook: https://www.facebook.com/speakupforyourhealth

This week, we want to take the opportunity to revisit our conversation with Iowa State Representative Megan Srinivas. She and co-host Ryan Coonerty talk about her journey as the child of immigrants in a small Iowa town, to a life changing visit to Kenya, to Harvard, and back to Iowa to represent disadvantaged communities. They discuss her storytelling strategies to create a middle ground on key issues like abortion and why medical professionals are well-positioned to run for office. Srinivas also explains how she embraces the diverse experiences of Iowans to align her messaging on key policy issues with people's needs. Tune in to learn about her big policy ideas rooted in her unique background and how she balances her medical and legislative duties. Enjoying An Honorable Profession? Subscribe to our YouTube channel for more great content! https://www.youtube.com/@NewdealleadersOrg/ • [01:06] An introduction to Iowa Representative Dr. Megan Srinivas and what motivates her to work in the legislature while practicing medicine. • [05:30] Her work to improve the Prior Authorization policy in the form of a bipartisan bill. • [07:42] A trip to rural Kenya that transformed how she relates to others. • [09:17] Formative experiences that sparked Dr. Srivas's interest in global health and policy. • [13:02] Applying global practices to rural Iowa by adopting a broader interpretation of healthcare. • [16:42] Reframing key policies in order to create a middle ground with those who disagree. • [19:38] Iowa's identity as a Purple State and what it takes to connect with Iowans. • [22:35] Predictions for 2024 and the messaging necessary to move the needle. • [24:45] Advice for healthcare practitioners who might want to run for office. • [26:01] How being a medical professional has helped Dr. Srinivas to build relationships. • [29:23] The dearth of mental health support and facilities in Iowa and what needs to change. • [31:46] Why there is an education crisis in Iowa and how this could be solved. • [33:22] How Dr. Srinivas chooses to focus her energy in order to enact change.