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Surprise! But not the good kind

You got your COVID-19 vaccine. You get your COVID-19 tests as necessary. Due diligence has been served, right? Well, don’t look behind you—here come the COVID-19 testing bills (and collection agencies). Per… Read More

Anthem forced to foot the bill for eating disorder coverage

Eating disorders are common—the mental health disorders affect nearly 30 million Americans. This is no small number, nor is the price tag associated with its care. An article in Becker’s Hospital Review… Read More

We have a hospital bed pile-up… that could easily be prevented

In a time when the Delta variant is raging and post-acute patient care is needed most, this is not the time for setbacks or bureaucracy. Leave it to insurers, though: Medicare Advantage… Read More

(Some) states push back on rate increases—finally!

It’s that time of year. No, not just for pumpkin spice lattes, but for health insurers to petition state Departments of Insurance for the next year’s rate increases. Everybody, brace yourselves. Each… Read More

D.C. Circuit overruling means the game is afoot!

A new court case has us predicting more False Claims Act suits against private payors operating Medicare Advantage plans. Let’s hope so, but first, let’s break it down. First: Medicare Advantage. Private… Read More

Who is responsible for preparing states for healthcare “storms”?

Storm preparation is a major priority for many cities across the nation, and rightly so. But where’s the preparation for healthcare “storms,” like COVID-19? Mississippi has what’s believed to be the weakest… Read More

Our take on Michigan insurers: “Another COVID-19 surge? Sounds like a ‘you’ problem…”

We sure hope you’re vaccinated, Michiganders! (And hope you don’t catch a breakthrough infection, despite your best efforts.) Your state’s two largest carriers are sunsetting COVID-19 cost waivers. You heard that right.… Read More

The prior authorization saga in Illinois could be making some headway

Introducing our newest hero: Illinois Governor JB Pritzker, who is throwing out new legislation for the betterment of healthcare in Illinois. The motive: calling into question the concept or execution of prior… Read More

Insurers keep going into overtime…and overtime…and overtime

When a football game goes into overtime, it’s exciting, competitive, and generally applauded. But when enforcement of health insurer transparency goes into overtime, it’s frustrating, exhausting, and costly. Per a recent Fierce… Read More

How much is your life worth? Apparently about $450

We’ve covered it before: UnitedHealthcare’s business practices often make mental healthcare harder to access—and it seems like New York State agrees. We’re happy to report, per a recent Reuters article, that the… Read More

Centene is not admitting fault for recent lawsuits…but still paying the price.

Centene might not be one of the Big Five health insurers, but it sure knows how to “follow the leader” when it comes to sneaky business. Oh, and did we forget to… Read More

The DOJ is AHA’s newest pen pal. Their mutual concern? United.

You can always count on the American Hospital Association (AHA) to address red flags from insurers, namely, UnitedHealthcare. Thumbs. Up. AHA’s latest effort involves a letter addressed to the Department of Justice… Read More

Two trips to space, or roughly $11B. That’s how much insurers profited in Q2 this year

Drum roll, please. It’s earning season once again and, sure enough, five of America’s largest health insurers cleaned up in Q2. We’re not just talking “cleaned up”—we’re talking bleached, waxed, and wiped… Read More

All aboard the insurer investment train to end-stage renal disease

We’re hearing a bit more than crickets from Cigna. According to a Modern Healthcare article, Cigna and Blue Shield of California participated in a $83.5M funding round for Cricket Health, a software… Read More

Aetna members might need to start sleeping with one eye open

Vision can be an overlooked element of health. But not for Aetna, who launched a new policy requiring prior authorization for all cataract surgeries as of July 1. Per a recent article… Read More

UnitedHealthcare is hitting pre-pandemic profit records…yippee.

It’s common knowledge at this point – insurers made a killing last year due to the pandemic. Limited care led to fewer medical claims, which led to more dollars in insurers’ pockets.… Read More

Top insurers are pushing for a (not-so-even) swap in medications

Many would argue that Coke is not the same as Pepsi, yet the taste is close enough that they could swap if the other was unavailable. When it comes to prescription drugs,… Read More

Playing payor Whac-A-Mole

The fun never ends when it comes to protecting patients from unfair out-of-network charges, per a July 30 Becker’s Review article.

The “insurer” will see you now

UnitedHealthcare’s profits seem to correlate with how much control they have over the industry, and according to a July 16 article in Axios, it’s more than we previously thought.

Up, up, and away: Anthem’s expectations for membership growth soar

Despite an already impressive growth in membership, Anthem is adding more to its expected year-end goals, reports a July 21 article in Healthcare Dive. Wondering how? Us, too!

The double-team PBM scheme from Anthem and Humana

What happens when two top insurers team up together to take over the PBM world? A July 26 article in Insider Intelligence has us wondering.

Still riding that health insurer merry-go-round

You pay for insurance to help pay for healthcare, which includes your prescription medications. So, what happens when they stop covering those expenses? That’s exactly what 85-year-old Juanita Freeman’s was surely asking… Read More

Another day, another telehealth coverage battle

And the telehealth saga continues. As we’ve said before, the COVID-19 pandemic opened many doors (even apps) for telehealth. Specifically, being able to provide patients access to care without going into the… Read More

When it comes to denying coverage, United’s like the Energizer Bunny… it never stops

We’ve covered a conglomeration of bad behavior from UnitedHealthcare – actions that many think negatively impact patients and providers alike, all in the name of profits. Now, we have a new ally… Read More

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