Connect with us

Science

A proposed law could force California health insurers to explain claim denials

Published

on

A proposed law could force California health insurers to explain claim denials

When Colleen Henderson’s 3-year-old daughter complained of pain while using the bathroom, doctors brushed it off as a urinary tract infection or constipation, common maladies in the potty-training years.

Henderson, however, suspected it could be something worse, and asked for an ultrasound. The doctor and ultrasound technician told her that her insurance provider, UnitedHealthcare, would not cover it, but Henderson decided to do it anyway, charging the $6,000 procedure to her credit card. Then came the news: There was a grapefruit-sized tumor in her toddler’s bladder.

That was in 2008. The next five years, Henderson said, became a protracted battle with UnitedHealthcare over paying for the specialists who finally diagnosed and treated her daughter’s rare condition, inflammatory pseudotumor. She appealed denial of coverage for hospital stays, surgeries and medication to the insurer and state regulators, to no avail. The Sacramento-area family racked up more than $1 million in medical debt, she said, because UnitedHealthcare had decided that treatments recommended by doctors were unnecessary. The family declared bankruptcy.

“If I had not fought tooth and nail every step of the way, my daughter would be dead,” said Henderson, whose daughter eventually recovered and is now a thriving 20-year-old junior at Oregon State University. “You pay a lot of money to have health insurance, and you hope that your health insurance has your well-being at the forefront, but that’s not happening at all.”

While insurance denials are on the rise, surveys show few Americans appeal them. Various analyses have found that many of those who escalate complaints to government regulators successfully get denials overturned (unlike the Hendersons). Consumer advocates and policymakers say that’s a clear sign insurance companies routinely deny care they shouldn’t. Now a proposal in the California legislature seeks to penalize insurers who repeatedly make the wrong call.

Advertisement

While the measure, Senate Bill 363, would cover only about a third of insured Californians whose health plans are regulated by the state, experts say it could be one of the boldest attempts in the nation to rein in health insurer denials — before and after care is given. And California could become one of only a handful of states that require insurers to disclose denial rates and reasoning, data the industry often considers proprietary information.

The measure also seeks to force insurers to be more judicious with denials, by fining them up to $1 million per case if more than half of appeals filed with regulators are overturned in a year.

In 2023, state data show, about 72% of appeals made to the Department of Managed Health Care, which regulates the vast majority of health plans, resulted in an insurer’s initial denial being reversed.

“When you have health insurance, you should have confidence that it’s going to cover your healthcare needs,” said Sen. Scott Wiener, the San Francisco Democrat who introduced the bill. “They can just delay, deny, obstruct, and, in many cases, avoid having to cover medically necessary care, and it’s unacceptable.”

A spokesperson for the California Assn. of Health Plans declined to comment, saying the group was still reviewing the bill‘s language. Gov. Gavin Newsom’s spokesperson Elana Ross said his office generally does not comment on pending legislation.

Advertisement

Concerned about spiraling consumer health costs, lawmakers in states across the nation have increasingly looked for ways to verify that insurers are paying claims fairly.

In 2024, 17 states enacted legislation dealing with prior authorization of care by private insurers, according to the National Conference of State Legislatures. For example, Connecticut, which has one of the most robust denial rate disclosure laws, publishes an annual report card detailing the number and percentage of claims each insurer has denied, as well as the share that ends up getting reversed. Oregon published similar information until recently, when state disclosure requirements lapsed.

In California, there’s no way to know how often insurers deny care, which health experts say is especially troubling as mental health needs are reaching crisis levels among children and young adults. According to Keith Humphreys, a health policy professor at Stanford University, it’s easier to deny mental health care because a diagnosis of, say, depression can be more subjective than that of a broken limb or cancer.

“We think it’s unacceptable that the state has absolutely no idea how big of a problem this is,” said Lishaun Francis, senior director of behavioral health for the advocacy group Children Now, a sponsor of the bill.

Under Wiener’s proposal, private insurers regulated by the state’s Department of Managed Health Care or Department of Insurance, or both, would be required to submit detailed data about denials and appeals. They would also need to explain those denials and report the outcomes of the appeals.

Advertisement

For appeals that make it to the state’s independent medical review process, or IMR, insurers whose denials are overturned more than half of the time would face staggering penalties. The first case that brings a company above the 50% threshold would trigger a fine of $50,000, with a penalty ranging from $100,000 to $400,000 for a second. Each one after that would cost the company $1 million.

If passed, the measure would apply to roughly 12.8 million Californians on private insurance. It would not apply to patients on Medi-Cal, the state’s Medicaid program, or Medicare, and it would exclude self-insured plans offered by large employers, which are regulated by the U.S. Department of Labor and cover roughly 5.6 million Californians.

The phrase “deny and delay” continues to reverberate across the healthcare industry after the killing of UnitedHealthcare Chief Executive Brian Thompson in December. In a survey by the research organization NORC at the University of Chicago, conducted shortly after the attack, 7 in 10 respondents said they believed denials for health coverage and profits by health insurance companies bore a great deal or a moderate amount of responsibility for Thompson’s death.

Following Thompson’s death, UnitedHealthcare said in statements that “highly inaccurate and grossly misleading information” had been circulated about the way the company treats claims, and that insurers, which are highly regulated, “typically have low- to mid-single digit margins.”

Wiener called Thompson’s killing a “cold-blooded assassination,” and said his measure had grown out of a narrower proposal that failed last year aimed at improving mental health coverage for children and adults under age 26. But he acknowledged that the public’s reaction to the killing underscored the long-simmering anger many Americans feel about health insurers’ practices and the urgent need for reform.

Advertisement

Humphreys, the Stanford professor, said the U.S. health system creates strong financial incentives for insurers to deny care. And, he added, state and federal penalties are paltry enough to be written off as a cost of doing business.

“The more care they deny, the more money they make,” he said.

Increasingly, large employers are starting to include language in contracts with claim administrators that would penalize insurance providers for approving too many or too few claims, said Shawn Gremminger, president of the National Alliance of Healthcare Purchaser Coalitions.

Gremminger represents mostly large employers that fund their own insurance, are federally regulated, and would be excluded from Wiener’s bill. But even for the so-called self-funded plans, it can be nearly impossible to determine denial rates for the insurance companies hired simply to administer claims, he said.

While the bill may be too late for many families, Sandra Maturino of Rialto said she hopes lawmakers tackle insurance denials so other Californians can avoid the saga she endured to get her niece treatment.

Advertisement

She adopted the girl, now 13, after her sister died. Her niece had long struggled with self-harm and violent behavior, but when therapists recommended inpatient psychiatric care, her insurer, Anthem Blue Cross, would cover it for only 30 days.

For more than a year, Maturino said, her niece cycled in and out of facilities and counseling because her insurance wouldn’t cover a long-term stay. Doctors tested a laundry list of prescription drugs and doses. None of them worked.

Anthem declined to comment for this story.

Unlike so many others in similar situations, Maturino was eventually able to get outside assistance to remedy the situation. She asked her adoption agency for help, and it ended up covering the cost of her niece’s stay in a residential program in Utah, where she was diagnosed with bipolar disorder and has been undergoing treatment for a year.

Maturino said she didn’t have the energy to appeal to Anthem.

Advertisement

“I wasn’t going to wait around for the insurance to kill her, or for her to hurt somebody,” Maturino said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Science

Why new dads shouldn’t panic about low testosterone

Published

on

Why new dads shouldn’t panic about low testosterone

Three months after his son was born, Kevin Maguire felt alone.

It was 2019. He had recently moved to Barcelona with his wife and daughter and was working on marketing projects for Fortune 500 companies. The birth of his son, Bodhi, should have been a joyous event. But Maguire, now 43, became sad and irritable, and didn’t want to be around his newborn. He withdrew from family and friends, often playing video games late into the night or finding excuses to get out of the house.

“I would take the dog out for a walk,” Maguire said. “I wanted to get far away enough that I wouldn’t bump into anyone I knew and I would just sit and cry.”

Desperate for answers, he entered his symptoms online. Maguire, author of the recently published book “The New Fatherhood: Why Everything They Told You About Being a Dad Is Wrong, and How Embracing It Will Transform Your Life,” knew to look for signs of the “baby blues” in his wife. But he was surprised by articles that said men could experience postpartum depression too. The diagnosis resonated and he began writing about his condition and the trials of fatherhood on Substack.

Advertisement

New dads face psychological pressures, from sleepless nights to sky-high bills, which can contribute to postpartum depression. So can shifting hormone levels.

“One thing I found in my lab’s research is that when new dads have really low levels of testosterone, they might report more symptoms of postpartum depression,” said Darby Saxbe, a professor of psychology at USC and author of the recently published “Dad Brain: The New Science of Fatherhood and How It Shapes Men’s Lives.”

While hormonal shifts can create challenges, they also help men adapt to fatherhood, Saxbe explained. Several hormones can spike in men when they become dads, including oxytocin, linked to better relationship quality; vasopressin, associated with emotional bonding; and prolactin, which promotes lactation in women and caregiving behavior in guys.

New dads can also experience a decline in testosterone. According to a 2011 paper from University of Notre Dame professor Lee Gettler, part of the largest study on fatherhood and testosterone ever conducted, men averaged around a 25% drop in testosterone after becoming fathers.

While dads have reasons to be concerned by plummeting levels of testosterone, a modest dip isn’t necessarily a disaster — in fact, it can make men better parents and partners.

Advertisement

“We often get invested in the idea that men should always have the highest possible levels of testosterone,” Saxbe said. “What the research tells us is a little more nuanced. You really want flexibility. You want a hormonal system that can adapt to the different demands of your life.”

The prospect of a decline might scare soon-to-be fathers, especially those on TikTok and Instagram, where accounts push the idea that having “high T” is the key to being a “real man,” according to a recent study in the journal Social Science & Medicine.

Influencers stand to profit persuading men there’s a widespread “masculinity crisis,” the researchers found, noting that 72% of the accounts they analyzed had a stake in testosterone supplements and treatments.

But studies show more testosterone isn’t always better. “We found that when dads have higher testosterone, even before birth, they’re less invested [than men with lower testosterone] in co-parenting a few months after birth,” Saxbe said. High T fathers were more stressed from parenting than their lower T counterparts, and had partners who were less satisfied in their romantic relationships.

This jibes with the challenge hypothesis, which says, in multiple species, testosterone levels rise when males battle for attention from potential mates and go down when it’s time to take care of the young.

Advertisement

While a small decline can be adaptive, dads face mental health risks when their testosterone drops too low.

There is no “normal” level of testosterone, said Dr. Jesse Mills, director of the Men’s Clinic at UCLA Health. Experts recommend that men should consider treatment if their levels dip below 300 nanograms per deciliter (ng/dL). But men metabolize testosterone in different ways, meaning a healthy level for one might be low for another.

“If a new dad comes to me and his testosterone is 298 [ng/dL], he’s below the threshold,” Mills said. “But if he has zero symptoms and everything else is going great — he’s over the moon with his new child, he’s so happy — that’s not somebody I’m going to treat with testosterone.”

He notes that the drop in testosterone fathers experience can partly be attributed to the stresses that come with a new kid: less sleep, a poor diet and fewer trips to the gym. That means there are precautions that expectant fathers can take that don’t involve testosterone replacement therapy (TRT).

Still, while some guys with low testosterone levels might not need TRT, others in the “normal” range could benefit from treatment. (Dads who want another kid soon, beware. Mills notes that testosterone replacement therapy can take a man’s sperm count to zero.)

Advertisement

Both Mills and Saxbe stress that men should be paying attention to symptoms of low testosterone — such as depression and low libido — rather than trying to reach or maintain an ideal number. They also agree that tending to mental health concerns is hugely important for new fathers.

Eventually, after Maguire researched his condition, he recovered after time spent meditating, exercising and bonding with his son.

“A lot of new dads don’t realize how much they’re struggling because they feel ashamed or because they don’t realize it’s common shortly after the birth of a baby,” Saxbe said.

When they struggle, fathers can fixate on testosterone because that’s what modern culture tells them will make them feel better. And sometimes testosterone replacement therapy works. But Saxbe stresses a lot of men could use psychotherapy or support groups that bring dads together, as well as more time bonding with loved ones in general.

“The thing that predicts a man’s well-being and longevity is the quality of his relationships with other people,” said Saxbe. “You can be the world’s best weightlifter. You can have a low body-fat percentage. You can be killing it at work. Those things don’t predict how happy you’re going to be at 80.”

Advertisement
Continue Reading

Science

Video: NASA Announces Artemis III Crew

Published

on

Video: NASA Announces Artemis III Crew

new video loaded: NASA Announces Artemis III Crew

transcript

transcript

NASA Announces Artemis III Crew

NASA announced the crew of Artemis III mission, which will fly to low-Earth orbit to test rendezvous and docking maneuvers with one or two lunar landers.

“I am excited to welcome you as the next crew in the Artemis journey to successfully return to the moon — this time to stay.” “I’m honored by the role that I’ve been given. I’m also very humbled by the task in front of us. But first and foremost, I’m grateful.” “So with that, the Artemis II crew, comrade, hands you the baton. You got the controls.” “As you know, we had a significant anomaly at our Launch Complex 36A on May 28. We’ve redoubled our efforts and are moving forward.”

Advertisement
NASA announced the crew of Artemis III mission, which will fly to low-Earth orbit to test rendezvous and docking maneuvers with one or two lunar landers.

By Alisa Shodiyev Kaff

June 9, 2026

Continue Reading

Science

Santa Monica Mountains’ last steelhead trout survived the Palisades fire — and even had babies

Published

on

Santa Monica Mountains’ last steelhead trout survived the Palisades fire — and even had babies

Scientists feared the Santa Monica Mountains’ last remaining steelhead trout were dead, smothered by debris flows unleashed by the Palisades fire.

But the endangered fish surprised them: A team of biologists recently spotted 30 of the rare trout — and 21 babies — in Topanga Creek.

“There was a lot of happy dancing in the creek,” said Rosi Dagit, principal conservation biologist for the Resource Conservation District of the Santa Monica Mountains, which works with public and private landowners to conserve natural resources.

That’s because the steelhead here are endangered, at both the state and federal levels. Once, they swam in most streams of the Santa Monicas, but their numbers plummeted amid overfishing and coastal development. Increasingly frequent wildfire has further stressed their habitat. Topanga Creek, a biodiversity hot spot, is home to their last known population in the mountains that stretch from the Hollywood Hills to Point Mugu in Ventura County.

The trout that were spotted, including this one, are part of a distinct Southern California population that’s listed as endangered at the state and federal levels.

Advertisement

(RCDSMM Stream Team)

The California Department of Fish and Wildlife spearheaded a complex mission to rescue trout threatened by the Palisades fire that sparked in January 2025.

Time was of the essence. The fire hadn’t yet been fully contained. But rain was on the way, which would sweep massive amounts of sediment from the denuded hillsides into the water. Fish are often killed this way.

Crews stunned the fish with electricity, scooped them up in buckets, trucked them to a hatchery and ultimately moved them to Arroyo Hondo Creek in Santa Barbara County.

Advertisement

Within days, Topanga Creek was choked with mud. Some assumed the fish left behind were goners.

But in March, the conservation district’s team found four. The following month, when water conditions were clearer, they saw more.

“These fish continue to amaze me,” said Kyle Evans, environmental program manager for the state Department of Fish and Wildlife, who had seen the damage to the creek. “I had seen populations get wiped out in similar situations. So when I heard, I was thrilled.”

Evans surmises the fish that survived were in an area of the creek where less charred material and sediment were swept in.

“These fish likely hunkered down, were hiding under some rocks or places to try to get away from the main concentration of flow,” he said. “And luckily they weren’t buried.”

Advertisement

The ones that were spotted were fairly small, around 6 to 14 inches. Rainbow trout and steelhead trout are the same species, but with different lifestyles. If the fish remain in freshwater, they’ll be considered rainbows. However, they can migrate to the ocean and become steelhead, where they typically grow larger before returning to their natal waters to spawn.

Topanga Creek hasn’t fully recovered from the damage it sustained, but scientists say it’s looking better. Surveys last year were “so depressing,” Dagit said, with very few animals, and stretches that were essentially transformed into flat roads from all the sediment buildup. Some of the riparian canopy burned right down to the creek.

Then came 32 inches of rain over the last nine months, scouring out and moving sediment, creating deeper pools. Dagit said they recently found newt egg masses for the first time in years, as well as a few adult newts and many frogs. Plants that provide cover are starting to recover.

She provided photos comparing certain pools last year and this year, some dramatically transformed. In September 2025, the Shrine Pool could have been an overgrown hiking trail. This April, it was filled with shallow water.

Shrine Pool, Sept. 2025, left, and the same location, April 2026, right.

The Shrine Pool in September 2025, left, and the same location in April 2026, right, with RCDSMM’s Isaac Yelchin donning a wetsuit.

(RCDSMM Stream Team)

Advertisement

Topanga Creek is home to another endangered fish, the small but hardy northern tidewater goby, often described as cute. Not long before the trout operation, Dagit led a rescue of hundreds of these fish too. Many were repatriated to the lagoon at the mouth of the creek in a moving ceremony last June.

There’s still the matter of what to do with the trout that were moved to Santa Barbara County last year. Evans would like to bring them home to the Santa Monicas at some point, but isn’t sure if it will happen. On one hand, they could bolster the small, genetically isolated surviving population. On the other, they might inadvertently bring in a disease or bacteria. There is some time to decide. Evans estimates the creek still needs to recover for two to three more years.

For now, the fish are functioning fine in their adopted creek. Experts worried the trauma wrought by the move would disrupt their spawning process, but they had babies that spring. This year, they spawned again.

Advertisement
Continue Reading
Advertisement

Trending