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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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2 Pennsylvania firefighters killed in vehicle collision during a search for a missing woman

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2 Pennsylvania firefighters killed in vehicle collision during a search for a missing woman


RICHMOND TOWNSHIP, Pa. — Two firefighters traveling in a utility vehicle along a Pennsylvania road during a search for a missing woman were killed in a head-on crash with a car, officials said.

The two members of the Walnuttown Fire Company died after the crash with a Toyota Camry at about 6 p.m. Saturday, roughly 45 miles (72 kilometers) northwest of Philadelphia. Fire Chief Jeff Buck and Assistant Fire Chief Robert Shick Jr. were heading north when they were struck by a sedan heading south on Route 222, according to the Berks County Coroner.

NBC Philadelphia reported that the utility vehicle was riding on the shoulder of Route 222 when the Camry swerved off of the road. Police told the station that a male and a female who were in the Camry when it crashed fled and were later arrested.

Video from the crash scene shows the utility vehicle on its side.

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No further details about the arrest or the search for the missing woman were immediately available Sunday.

A call and an email seeking information were made to the Fleetwood Police Department.

Autopsies on the firefighters, both residents of Fleetwood, were scheduled for Monday.

“At this time we would like to send our thoughts and prayers” to the Shick and Buck families, the Walnuttown Fire Company said in a Facebook post. “Rest easy chiefs, we got it from here.”

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Toddler injured by wolf after crawling under Pennsylvania zoo’s exterior metal fence

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Toddler injured by wolf after crawling under Pennsylvania zoo’s exterior metal fence


A toddler was lightly injured by a wolf at a Pennsylvania theme park zoo after he crawled under a fence and stuck his hand into the animal’s enclosure, officials at the zoo confirmed Sunday.The child was never inside the wolf habitat at the ZooAmerica North American Wildlife Park, which is part of the Hersheypark theme park, and the officials characterized the injuries as minor without elaborating.After the “unsupervised” child reached the metal enclosure around the wolf habitat on Saturday morning and put his hand through, a wolf approached “and made contact with the child’s hand,” according to a statement from the zoo.”This type of response is consistent with natural animal behavior, and was not a sign of aggression,” the zoo said in a statement. “Our habitats are designed with multiple layers of protection, and clear signage and barriers are in place to help ensure safe viewing. Guests are expected to remain within designated areas and closely supervise children at all times.”The zoo is part of the entertainment complex in Hershey, Pennsylvania, featuring a chocolate-themed amusement park. The zoo’s website says it has three gray wolves.Hersheypark made headlines last summer when a lost boy wandering a monorail line above a crowd was rescued by a park visitor who climbed onto a building and jumped onto the rails. The child was unharmed and reunited with his family.

A toddler was lightly injured by a wolf at a Pennsylvania theme park zoo after he crawled under a fence and stuck his hand into the animal’s enclosure, officials at the zoo confirmed Sunday.

The child was never inside the wolf habitat at the ZooAmerica North American Wildlife Park, which is part of the Hersheypark theme park, and the officials characterized the injuries as minor without elaborating.

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After the “unsupervised” child reached the metal enclosure around the wolf habitat on Saturday morning and put his hand through, a wolf approached “and made contact with the child’s hand,” according to a statement from the zoo.

“This type of response is consistent with natural animal behavior, and was not a sign of aggression,” the zoo said in a statement. “Our habitats are designed with multiple layers of protection, and clear signage and barriers are in place to help ensure safe viewing. Guests are expected to remain within designated areas and closely supervise children at all times.”

The zoo is part of the entertainment complex in Hershey, Pennsylvania, featuring a chocolate-themed amusement park. The zoo’s website says it has three gray wolves.

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Hersheypark made headlines last summer when a lost boy wandering a monorail line above a crowd was rescued by a park visitor who climbed onto a building and jumped onto the rails. The child was unharmed and reunited with his family.



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MSU football locks in official visit with underrated CB prospect from Pennsylvania

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MSU football locks in official visit with underrated CB prospect from Pennsylvania


Michigan State football has locked in an official visit with an intriguing defensive back prospect from Pennsylvania.

Trey Hopkins of Wyndmoor, Pa. announced on Saturday that he’s scheduled an official visit to Michigan State for late May. According to a social media post from Hopkins, he will visit Michigan State on May 29.

Hopkins is currently unranked and unrated on 247Sports. He is listed at 6-foot-2 and 195 pounds, and plays for La Salle College. His position is listed as cornerback.

Michigan State extended Hopkins an offer in late February, and is one of nearly 20 schools to offer him, according to 247Sports. Other than his offer from the Spartans, Hopkins has received offers from Penn State, Maryland, UCLA, Virginia Tech, Maryland, Wake Forest, USF, Temple, James Madison, Liberty, Miami (OH) and some other group of five or FCS programs.

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Michigan State will be the first of three currently scheduled official visits for Hopkins. According to 247Sports, he will also take official visits to Virginia Tech (June 5) and Penn State (June 11).

Contact/Follow us @The SpartansWire on X (formerly Twitter) and like our page on Facebook to follow ongoing coverage of Michigan State news, notes and opinion. You can also follow Robert Bondy on X @RobertBondy5.





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