Insurers can discontinue plans, remove physicians and restrict access. Patients deserve to know what they are buying before they need care.

UnitedHealthcare terminated us.

Not from our entire contract, only from its Medicare Advantage network.

The Sept. 1 letter says UHC is “making changes” to its network. Effective Dec. 1, The Hirsh Center for Arthritis and Sports Medicine will be excluded from Medicare Advantage contracts while remaining in UHC’s other plans. (We are appealing this decision)

The letter identifies no quality failure or performance deficiency. Our signature is not required.

What good is a lower drug price if patients cannot find a practice that can afford to treat them? Congress can address that threat by advancing H.R. 4299.

In a congressional office last week, my heart began racing as I explained what a Medicare reimbursement change could mean for our patients.

I came prepared to discuss drug pricing. But my throat tightened as I thought about losing access to the medication that has controlled my psoriatic arthritis for eight years.

UnitedHealthcare told us to proceed. 

We verified the patient’s benefits. UnitedHealthcare issued prior authorization for Benlysta. GSK’s BENLYSTA Gateway conducted a separate benefits investigation and also identified UnitedHealthcare. 

Our private rheumatology practice purchased the medication, administered five infusions, submitted the claims and received payment. 

More than a year later, UnitedHealthcare clawed back approximately $15,000.

For the second consecutive year, insurers are seeking double-digit premium increases for ACA marketplace plans.

But rising premiums aren’t the real story.

They’re exposing a problem that has existed since the ACA marketplace began.

Were ACA marketplace plans ever truly affordable if patients struggled to use them?

The federal government loves to say it “oversees” Big Insurance.

In reality, it often supervises from a safe distance while insurers engineer aggressive workarounds in plain sight. Chris Deacon’s latest Substack piece on Anthem’s Federal Employees Health Benefits Program contract reads like a sharp case study in how power quietly shifts from the regulator to the regulated.

I’m watching something heartbreaking happen to Gen Z, and it’s not just on their phones.

It’s in their brains.

On my latest Working Healthcare podcast episode, “Wine, Weed and the Next Generation,” I sit down with my Zoomer son to ask why he calls high-THC cannabis “the stupid drug” of his generation — and how we are on course to destroy his entire peer group.

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Rheumatology hasn’t been “gobbled up” yet (Thanksgiving pun fully intended), but after reading the latest Becker's Healthcare’s analysis on physician M&A, it’s clear we’re on the menu. A handful of massive healthcare organizations are redrawing the physician landscape through aggressive acquisitions, vertical integration and high-stakes partnerships.

‍Here’s the part that should make every independent rheumatologist sit up.

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We all know it — American health care costs more than any other nation. Nobody working inside the system needs another headline to prove that point. We see it in the denials, the administrative bloat, the endless billing gymnastics we perform just to keep the lights on. But it’s worth asking: why does it cost so much?

Ever wonder if William Shatner, Medicare Advantage pitchman in chief, actually has a Medicare DisAdvantage plan or Traditional Medicare?
 
You can sell anything if you believe in it. Captain Kirk doesn’t share his plan details, and either does ChatGPT – HIPAA is strong.

Must-know for Medicare open enrollment: the $2,100 cap, smoothing — and the self-administered drug trap

Open enrollment runs Oct. 15 - Dec. 7. Your 2026 playbook needs three pivots that hit adherence, scheduling and cash flow.

My mom is sick. I’m not asking for sympathy. She has a chronic illness and she’s been sick a long time. That’s her story to tell.

Mine is about what happens when a person with a chronic disease is a part of a large “integrated” health system and the integration never shows up.

I have owned a medical practice for over a decade, 12 years and 2 months to be precise. I have certainly made some bad decisions, but one must learn from a mistake in order to make it a learning opportunity. Fortunately, I have made more good decisions than bad ones, thus I claim success. To share my success story with others allows for me to continue to ingrain the learning opportunities I have experienced. While I am a mother, University instructor, medical practice Vice President, and business owner, I aspire to inspire and mentor my children, students, employees, colleagues and those I continue to meet along life’s journey.

Did you know that less than 1% of denied insurance claims are appealed—but more than 50% of those that are, actually succeed? That stat alone should give every patient hope. It’s a reminder that when insurance says “no,” that doesn’t mean the fight is over. In fact, it’s often just the beginning.

Risk is inevitable, but how you assess risk and manage a crisis is essential to the success of your business. Many of us are so hyper-focused on the myriad of variables associated with providing quality patient care that we forget we are in the business of healthcare.