Persius
@persiusorg.bsky.social
Empowering collective action in healthcare through digital tools, data, and patient advocacy. We help people with coverage denials for free.
persius.org
Newsletter:
https://persius.org/newsletter
persius.org
Newsletter:
https://persius.org/newsletter
Actual insurance denial. Overturned after review by an independent third party.
November 22, 2025 at 8:16 PM
Actual insurance denial. Overturned after review by an independent third party.
Health insurers rely on patients and physicians being too unwell or burnt out to seek appeals.
Attrition is critical to making wrongful denials profitable.
Attrition is critical to making wrongful denials profitable.
November 22, 2025 at 1:00 AM
Health insurers rely on patients and physicians being too unwell or burnt out to seek appeals.
Attrition is critical to making wrongful denials profitable.
Attrition is critical to making wrongful denials profitable.
We requested Medicare appeal outcomes. CMS had delayed indefinitely.
This data is more important than ever, as MA is being pushed, and trad Medicare is using AI.
This data belongs to the public. Please help us in making this request visible.
This data is more important than ever, as MA is being pushed, and trad Medicare is using AI.
This data belongs to the public. Please help us in making this request visible.
The Data Liberation Project — Medicare "Level 2" Appeals
We’re requesting database records tracking the circumstances and outcomes of patients’ appeals of Medicare insurance decisions.
www.data-liberation-project.org
November 20, 2025 at 11:00 PM
We requested Medicare appeal outcomes. CMS had delayed indefinitely.
This data is more important than ever, as MA is being pushed, and trad Medicare is using AI.
This data belongs to the public. Please help us in making this request visible.
This data is more important than ever, as MA is being pushed, and trad Medicare is using AI.
This data belongs to the public. Please help us in making this request visible.
Due to influence, power, and minimal enforcement, we continue to see insurers get away with illegal practices with palatable consequences.
This is unacceptable.
In collaboration with the patients we work with we are building an evidence base to document bad faith, illegal, and deadly behaviors.
This is unacceptable.
In collaboration with the patients we work with we are building an evidence base to document bad faith, illegal, and deadly behaviors.
November 19, 2025 at 9:00 PM
Due to influence, power, and minimal enforcement, we continue to see insurers get away with illegal practices with palatable consequences.
This is unacceptable.
In collaboration with the patients we work with we are building an evidence base to document bad faith, illegal, and deadly behaviors.
This is unacceptable.
In collaboration with the patients we work with we are building an evidence base to document bad faith, illegal, and deadly behaviors.
The call center racket is a key part of the health insurance racket.
November 19, 2025 at 4:07 PM
The call center racket is a key part of the health insurance racket.
We help patients fight health insurance denials for free. Reach out if you need help.
info@persius.org
info@persius.org
November 19, 2025 at 12:43 AM
We help patients fight health insurance denials for free. Reach out if you need help.
info@persius.org
info@persius.org
Rarely discussed is the rate of denials for purported lack of 'medical necessity'.
Many of the most harmful denials are made on this basis. Useful to track them specifically, who administers them the most, and which patient populations face them the most. Overall denial rates don't tell this story.
Many of the most harmful denials are made on this basis. Useful to track them specifically, who administers them the most, and which patient populations face them the most. Overall denial rates don't tell this story.
November 18, 2025 at 5:31 PM
Rarely discussed is the rate of denials for purported lack of 'medical necessity'.
Many of the most harmful denials are made on this basis. Useful to track them specifically, who administers them the most, and which patient populations face them the most. Overall denial rates don't tell this story.
Many of the most harmful denials are made on this basis. Useful to track them specifically, who administers them the most, and which patient populations face them the most. Overall denial rates don't tell this story.
13% of prior authorization denials in Medicare Advantage meet Medicare coverage rules and are supposed to be covered.
November 18, 2025 at 3:14 PM
13% of prior authorization denials in Medicare Advantage meet Medicare coverage rules and are supposed to be covered.
Insurer representatives who can help with appeals are often unreachable. We make calls daily.
Call the number on your denial? "Wrong number."
Transfer me? "Can't do that."
They'll call back? They won't.
Attrition by design. We document this, and intend to hold those responsible accountable.
Call the number on your denial? "Wrong number."
Transfer me? "Can't do that."
They'll call back? They won't.
Attrition by design. We document this, and intend to hold those responsible accountable.
November 15, 2025 at 1:00 AM
Insurer representatives who can help with appeals are often unreachable. We make calls daily.
Call the number on your denial? "Wrong number."
Transfer me? "Can't do that."
They'll call back? They won't.
Attrition by design. We document this, and intend to hold those responsible accountable.
Call the number on your denial? "Wrong number."
Transfer me? "Can't do that."
They'll call back? They won't.
Attrition by design. We document this, and intend to hold those responsible accountable.
External appeal overturn rates are supposed to be low. High rates mean internal appeal processes are not working.
The external appeal overturn rate among people with cancer on Managed Long Term Care plans in New York is 85%.
Read the report here:
The external appeal overturn rate among people with cancer on Managed Long Term Care plans in New York is 85%.
Read the report here:
New York Data Suggest Coverage Denials Put Most Vulnerable Patients At Risk
People’s Action Executive Director Sulma Arias condemns Trump’s Senate budget as a violent attack on working families—cutting Medicaid, housing, and food to fund tax breaks for billionaires. The…
peoplesaction.org
November 12, 2025 at 9:01 PM
External appeal overturn rates are supposed to be low. High rates mean internal appeal processes are not working.
The external appeal overturn rate among people with cancer on Managed Long Term Care plans in New York is 85%.
Read the report here:
The external appeal overturn rate among people with cancer on Managed Long Term Care plans in New York is 85%.
Read the report here:
Health insurers go to great lengths to defend the indefensible, because they count on us giving up.
November 12, 2025 at 4:07 PM
Health insurers go to great lengths to defend the indefensible, because they count on us giving up.
If you appreciate our work and are in a position to donate, we are grateful for anything you can give. Link in bio.
We help people appeal coverage denials for free, and have overturned over $600k. We prioritize support for time sensitive, critical care.
We help people appeal coverage denials for free, and have overturned over $600k. We prioritize support for time sensitive, critical care.
November 12, 2025 at 12:43 AM
If you appreciate our work and are in a position to donate, we are grateful for anything you can give. Link in bio.
We help people appeal coverage denials for free, and have overturned over $600k. We prioritize support for time sensitive, critical care.
We help people appeal coverage denials for free, and have overturned over $600k. We prioritize support for time sensitive, critical care.
HHS OIG:
"MAO denied a request for a walker (estimated cost $112) for a 76-year-old beneficiary with post-polio syndrome. The MAO stated that, per its clinical criteria, the beneficiary was not eligible to receive a walker because the beneficiary had already received a cane within the last 5 years."
"MAO denied a request for a walker (estimated cost $112) for a 76-year-old beneficiary with post-polio syndrome. The MAO stated that, per its clinical criteria, the beneficiary was not eligible to receive a walker because the beneficiary had already received a cane within the last 5 years."
November 11, 2025 at 3:07 PM
HHS OIG:
"MAO denied a request for a walker (estimated cost $112) for a 76-year-old beneficiary with post-polio syndrome. The MAO stated that, per its clinical criteria, the beneficiary was not eligible to receive a walker because the beneficiary had already received a cane within the last 5 years."
"MAO denied a request for a walker (estimated cost $112) for a 76-year-old beneficiary with post-polio syndrome. The MAO stated that, per its clinical criteria, the beneficiary was not eligible to receive a walker because the beneficiary had already received a cane within the last 5 years."
Each year, there are over 290,000 denials administered in state-regulated commercial health insurance plans in New York for alleged 'lack of medical necessity'.
Many are necessary.
Many are necessary.
November 6, 2025 at 11:01 PM
Each year, there are over 290,000 denials administered in state-regulated commercial health insurance plans in New York for alleged 'lack of medical necessity'.
Many are necessary.
Many are necessary.
Proprietary guidelines are a linchpin of health insurance denials.
Insurers pay doctors to write guidelines. Then they deny coverage, pointing to the guidelines as justification.
We analyze guidelines daily. They mischaracterize, and cherry-pick.
Guidelines should not be developed by insurers.
Insurers pay doctors to write guidelines. Then they deny coverage, pointing to the guidelines as justification.
We analyze guidelines daily. They mischaracterize, and cherry-pick.
Guidelines should not be developed by insurers.
November 6, 2025 at 2:16 PM
Proprietary guidelines are a linchpin of health insurance denials.
Insurers pay doctors to write guidelines. Then they deny coverage, pointing to the guidelines as justification.
We analyze guidelines daily. They mischaracterize, and cherry-pick.
Guidelines should not be developed by insurers.
Insurers pay doctors to write guidelines. Then they deny coverage, pointing to the guidelines as justification.
We analyze guidelines daily. They mischaracterize, and cherry-pick.
Guidelines should not be developed by insurers.
We’re working with someone who is being wrongly denied access to an independent medical review (IMR).
IMR is meant to ensure wrongful denials can be reviewed by independent doctors.
But the very insurers who wrongly deny coverage often determine qualification for IMR. And they often get it wrong.
IMR is meant to ensure wrongful denials can be reviewed by independent doctors.
But the very insurers who wrongly deny coverage often determine qualification for IMR. And they often get it wrong.
November 4, 2025 at 8:10 PM
We’re working with someone who is being wrongly denied access to an independent medical review (IMR).
IMR is meant to ensure wrongful denials can be reviewed by independent doctors.
But the very insurers who wrongly deny coverage often determine qualification for IMR. And they often get it wrong.
IMR is meant to ensure wrongful denials can be reviewed by independent doctors.
But the very insurers who wrongly deny coverage often determine qualification for IMR. And they often get it wrong.
"Our findings suggest that insurers may be targeting specific patient populations via inappropriate denial practices. "
From "Denied: The Harmful Role of Prior Authorization and Claim Denials."
You can read the full report here:
peoplesaction.org/new-york-dat...
From "Denied: The Harmful Role of Prior Authorization and Claim Denials."
You can read the full report here:
peoplesaction.org/new-york-dat...
November 1, 2025 at 7:16 PM
"Our findings suggest that insurers may be targeting specific patient populations via inappropriate denial practices. "
From "Denied: The Harmful Role of Prior Authorization and Claim Denials."
You can read the full report here:
peoplesaction.org/new-york-dat...
From "Denied: The Harmful Role of Prior Authorization and Claim Denials."
You can read the full report here:
peoplesaction.org/new-york-dat...
We regularly see what appears to be AI generated slop in health insurance denials.
These denials have extremely serious consequences for patients, and there needs to be accountability for failing to follow mandated procedure.
These denials have extremely serious consequences for patients, and there needs to be accountability for failing to follow mandated procedure.
November 1, 2025 at 12:49 PM
We regularly see what appears to be AI generated slop in health insurance denials.
These denials have extremely serious consequences for patients, and there needs to be accountability for failing to follow mandated procedure.
These denials have extremely serious consequences for patients, and there needs to be accountability for failing to follow mandated procedure.
Health insurance denials are rarely appealed, but those that are are frequently overturned. This suggests wrongful denials are not sufficiently disincentivized.
Wrongful denials have life threatening consequences for patients, and consequences need to be made correspondingly serious for insurers.
Wrongful denials have life threatening consequences for patients, and consequences need to be made correspondingly serious for insurers.
November 1, 2025 at 12:00 AM
Health insurance denials are rarely appealed, but those that are are frequently overturned. This suggests wrongful denials are not sufficiently disincentivized.
Wrongful denials have life threatening consequences for patients, and consequences need to be made correspondingly serious for insurers.
Wrongful denials have life threatening consequences for patients, and consequences need to be made correspondingly serious for insurers.
Insurers claim ‘insufficient evidence’ for proven treatments while selectively citing only the oldest literature. Then they disregard newer studies demonstrating efficacy.
Who’s gonna break the news that cherry picking literature to support a forgone conclusion is not scientific?
Who’s gonna break the news that cherry picking literature to support a forgone conclusion is not scientific?
October 31, 2025 at 1:16 PM
Insurers claim ‘insufficient evidence’ for proven treatments while selectively citing only the oldest literature. Then they disregard newer studies demonstrating efficacy.
Who’s gonna break the news that cherry picking literature to support a forgone conclusion is not scientific?
Who’s gonna break the news that cherry picking literature to support a forgone conclusion is not scientific?
Absurd denial: patient got doses 1&2 of a 3-dose vaccine. Insurer denied dose 3 because patient allegedly "aged out" mid treatment.
Stupid denial, overturned after a fight.
Insurers go to great lengths to defend the indefensible, because they count on us giving up.
Reach out if you need help.
Stupid denial, overturned after a fight.
Insurers go to great lengths to defend the indefensible, because they count on us giving up.
Reach out if you need help.
October 30, 2025 at 10:01 PM
Absurd denial: patient got doses 1&2 of a 3-dose vaccine. Insurer denied dose 3 because patient allegedly "aged out" mid treatment.
Stupid denial, overturned after a fight.
Insurers go to great lengths to defend the indefensible, because they count on us giving up.
Reach out if you need help.
Stupid denial, overturned after a fight.
Insurers go to great lengths to defend the indefensible, because they count on us giving up.
Reach out if you need help.
In 2020, New York State enacted legislation requiring health insurers to report aggregate claims data to increase transparency in coverage decisions.
The data shows that in 2023, denials overturned through internal appeal processes amounted to over $3 billion in billed charges.
The data shows that in 2023, denials overturned through internal appeal processes amounted to over $3 billion in billed charges.
October 30, 2025 at 1:16 PM
In 2020, New York State enacted legislation requiring health insurers to report aggregate claims data to increase transparency in coverage decisions.
The data shows that in 2023, denials overturned through internal appeal processes amounted to over $3 billion in billed charges.
The data shows that in 2023, denials overturned through internal appeal processes amounted to over $3 billion in billed charges.
Lots of talk about forthcoming health insurance premium hikes. Less talk about how even when people can pay their premiums, coverage they've paid for is regularly withheld through wrongful coverage denials. This belongs in the same conversation, and both are critical fights.
October 29, 2025 at 8:01 PM
Lots of talk about forthcoming health insurance premium hikes. Less talk about how even when people can pay their premiums, coverage they've paid for is regularly withheld through wrongful coverage denials. This belongs in the same conversation, and both are critical fights.
"External appeals serve a unique and critical role in ensuring access to justice for patients facing inappropriate denials. They provide a relatively unbiased, low-barrier pathway for patients to contest denials. In contrast, internal appeals lack a conceptual basis for impartiality."
October 29, 2025 at 3:09 PM
"External appeals serve a unique and critical role in ensuring access to justice for patients facing inappropriate denials. They provide a relatively unbiased, low-barrier pathway for patients to contest denials. In contrast, internal appeals lack a conceptual basis for impartiality."
Reposted by Persius
Losing your health coverage is bad enough. But for hundreds of thousands of workers, it could also mean losing a job.
New research shows the economic damage if enhanced ACA tax credits expire this year.
New research shows the economic damage if enhanced ACA tax credits expire this year.
Expiring ACA Premium Tax Credits Could Lead to Nearly 340,000 Jobs Lost Across the U.S. in 2026
Unless Congress acts quickly to extend the enhanced ACA marketplace premium tax credits, nearly 5 million people could lose health insurance coverage in 2026.
bit.ly
October 20, 2025 at 1:27 PM
Losing your health coverage is bad enough. But for hundreds of thousands of workers, it could also mean losing a job.
New research shows the economic damage if enhanced ACA tax credits expire this year.
New research shows the economic damage if enhanced ACA tax credits expire this year.