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Coverage denied: Patients suffer as layers of companies profit

Marcela Villa isn’t a big name in healthcare, but she played a crucial role in the lives of thousands of Medicaid patients in California. Her official title: denial nurse.

Each week, dozens of requests for treatment landed on her desk after preliminary rejections. Her job, with the assistance of a part-time medical director, was to conclusively determine whether the care—from doctor visits to cancer treatment—should be covered under the nation’s health insurance program for low-income Americans.

…“These private entities get very little oversight,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty in Sacramento, “and there’s real harm being done to patients.”

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