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Pennsylvania launches external review program for health insurance denials

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Pennsylvania launches external review program for health insurance denials


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When people get denied insurance coverage for a medical procedure or medication, they can usually appeal that decision directly with their health insurer. But if that doesn’t work, people are often left with limited options.

Now, a new Pennsylvania program will take up these cases and offer another chance for people to appeal the insurance company’s decision.

The Pennsylvania Insurance Department’s Independent Review Program launched this month. It assigns eligible cases to teams of doctors, specialists and other experts who determine if an insurance denial was correctly or incorrectly issued.

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If the independent review teams, contracted by the state, determine that a patient was wrongly denied coverage, then health insurers must overturn the denial and cover the service, medication or therapy equipment.

“If people believe it’s a service that they should have covered, we want to tell them to keep pushing,” said Shannen Logue, state Insurance Department deputy commissioner. “We want to empower the people to know that we’re here. We’ve made a really easy solution online for people so they can go ahead and request that [review].”

The program will take cases submitted by residents who have health plans they purchased through Pennie, the state’s Affordable Care Act marketplace; people who buy their insurance directly from a company; and workers who get health plans through their employers.

Eligibility is determined within five days after someone submits a request.

The program will then assign the case to a contracted independent review organization and team, which is followed by a 15-day “pause period” in which both the patient and the review team gathers additional documents and information relevant to the denial.

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Logue said review teams have 45 days to analyze the case. Most people will receive a decision within 60 days.

The program has an expedited process for people facing urgent life-threatening or serious health risks who may need a decision sooner.

The new review program is the result of state legislation signed into law by former Gov. Tom Wolf in 2022. It sought to expand state-based review services and support for people and their health insurance needs.



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Pennsylvania

Ticket sold in Pennsylvania worth $1M as Mega Millions swells to $1.15B for post-Christmas draw

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Ticket sold in Pennsylvania worth M as Mega Millions swells to .15B for post-Christmas draw


Billionaire dreams continue through Christmas after no ticket purchased in the $1 billion Christmas Eve 2024 Mega Millions draw hit the jackpot.

The jackpot rolled again — this time to $1.15 billion — after no ticket matched all six numbers drawn Tuesday, Dec. 24, 2024.

Léelo en español aquí.

Don’t throw away your tickets just yet as one sold in Pennsylvania is worth $1 million, according to Mega Millions.

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What were the winning Mega Millions numbers drawn on Christmas Eve?

The Mega Millions draw for Dec. 24, 2024, went like this: The white balls drawn were 11, 14, 38, 45 and 46, plus the gold Mega Ball 3.

Ticket sold in Pennsylvania strikes $1 million prize

In total, fours tickets sold matched all five white balls, but missed the gold Mega Ball, the lottery said. Those tickets sold in California, Missouri, Wyoming and Pennsylvania are worth $1 million a piece.

NBC10 has reached out to Pennsylvania Lottery to find out where the Keystone State winner was sold. However, the state lottery offices are closed for Christmas, so the winning store won’t be revealed until Thursday at the earliest, a spokesperson said.

Nearly 4.3 million tickets sold around the country in Tuesday’s draw matched at least the gold Mega Ball and are worth $2 or more.

Once again, the winning numbers in the Dec. 24, 2024, draw were 11, 14, 38, 45 and 46, with a Mega Ball of 3.

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If you or someone you know has a gambling addiction, please call the National Council on Problem Gambling at 1-800-522-4700 to speak to a counselor. Help is also available via an online peer support forum at www.gamtalk.org, and additional resources can be found at NCPG website.

When is the next Mega Millions draw?

Get out $2, jump into office pools and gift tickets to family as the next Mega Millions draw on Friday, Dec. 27, 2024, is worth at least $1.15 billion for the annuity and $516.1 million lump sum cash value, Mega Millions said.

That massive jackpot is the fifth largest in the game’s history, Mega Millions said.

“We know that many people will likely receive tickets to Friday’s drawing as holiday gifts, and what a gift that would turn out to be if you ended up with a ticket worth a $1.15 billion jackpot,” Joshua Johnston, lead director for the Mega Millions Consortium, said in a Christmas news release. “I can’t think of a better way to celebrate the holidays – whether Christmas, Hanukkah, Kwanzaa, the Winter Solstice, or any other way people choose to celebrate the season – than by helping fulfill the dreams that come with a prize like this and prizes that will be won at all levels of the game.”

What are the odds of winning the Mega Millions jackpot?

Mega Millions is played in 45 states, plus the Washington, D.C. and the U.S. Virgin Islands.

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The odds of winning the Mega Millions jackpot are 1 in 302,575,350.

When did someone last hit the Mega Millions jackpot?

It’s been since Sept. 10, 2024, since a ticket sold in Texas hit all five numbers and the Mega Ball to win an $810 million jackpot.

Good luck!



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Future Oscar Hammerstein Museum in Doylestown gets $500K in Pa. funds

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Future Oscar Hammerstein Museum in Doylestown gets 0K in Pa. funds


Junker said members of the executive committee have launched their own matching challenge, donating $100,000 once the same amount has been raised.

The museum bought Highland Farm a year ago from the previous owner who operated it as a Rodgers and Hammerstein–themed bed-and-breakfast. Hammerstein lived in the farmhouse for the last 20 years of his life, a period when he and composer Richard Rodgers created some of the most enduring musicals of American theater, including “The Sound of Music,” “Oklahoma” and “South Pacific.”

“Institutions like this help us to lead lives of purpose and meaning, they enrich our lives and provide opportunities for lifelong learning for folks of all ages,” said state Rep. Tim Brennan, a former board member of the museum. “Investing in this organization is an investment in our future.”

The first RACP grant in 2020 went toward buying the property and doing basic maintenance.

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“One of the first things we did was install a security system,” Junker said. “Because we have started to collect some artifacts.”



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2 Western Pennsylvania men charged in murder-for-hire plot confession to pastor, police say

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2 Western Pennsylvania men charged in murder-for-hire plot confession to pastor, police say


State police in Western Pennsylvania have charged two men in a murder-for-hire plot after one of the suspects allegedly confessed to his pastor.

NBC News affiliate WJAC reports David Vanatta, 49, and Colton Baird, 32, both of Elk County, were jailed for an alleged plot to kill Vanatta’s ex-wife.

An affidavit obtained by WJAC states Vanetta confessed to a pastor that he paid Baird $2,000 to kill his ex-wife. The pastor then reported the information to police.

Police say the ex-wife was never harmed.

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Online court records show Vanatta and Baird are facing several charges, including criminal solicitation – criminal homicide, conspiracy to commit criminal homicide and attempted homicide. Both men are being held in the Elk County Prison without bail.

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