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UnitedHealthcare officially walks back controversial ER policy

What’s that saying? When you find yourself in a hole, quit digging? Looks like UnitedHealthcare (United) finally caught wise that attempting to implement stricter criteria for emergency services was ditch-digging at its finest. In… Read More

Will insurer investments make behavioral healthcare easier – or harder – to access?

Telebehavioral health has become critical in providing global access to mental and behavioral health services. While telebehavioral health is not new by any means, it’s experienced an explosion of growth since the… Read More

What’s the strategy behind Cigna’s investment plays?

Welcome to the Players Club…of insurers, that is, and the alliances and partnerships are only getting more complex. Per a recent article in Axios, Cigna has invested $750 million into Bright Health,… Read More

Our Un-covered hero of the month: Insurance fighter Jackie Fox

If there was a good egg in the Un-covered world, it would be law professor Jackie Fox, who takes on patients’ insurance battles for fun – and wins. Kaiser Health News’ podcast… Read More

UnitedHealthcare’s tactics aren’t so bright in the Sunshine State

It’s time to roll out the insurer red carpet – straight to court! According to an article in the Orlando Sentinel, UnitedHealthcare (United) recently shelled out more than $4.7 million to UF… Read More

The Three Worst Insurance Trends of 2021

Insurance companies sure found plenty of creative ways to make money in 2021. Some we expected, some were new, and many made it harder for patients to access the healthcare services they… Read More

Centene and the settlement saga

“Centene” and “settlement” are two words that have come up so many times this year, we can’t even count. And it’s not stopping yet. Another million-dollar settlement is on the table for… Read More

More insurers caught underpaying COVID-19 claims – here’s looking at you, Anthem

A few weeks ago, we shared that after providers – namely, pediatricians – complained that the insurer was paying them substantially below market rate to administer COVID-19 vaccines, UnitedHealthcare agreed to reprocess its COVID-19… Read More

Seeing beyond the peak of UnitedHealthcare’s revenues

No mountain is too high when it comes to revenue expectations for UnitedHealthcare. 2020 was good, 2021 was better, and in 2022, we can’t even see the peak yet. Per a recent… Read More

Humana pats itself on the back in new report

“Home health” has been a buzzword for years, even more so during the pandemic. It’s also been an investment focus for many health insurers – most notably, Humana. But two recent stories… Read More

The (first) jury is in, and UnitedHealthcare takes the hit

The jury has deliberated; the gavel has landed, and an insurance company is forced to face the repercussions of its actions. According to a recent article in Modern Healthcare, Tennessee-based emergency physician company… Read More

Insurers start to feel the contract-cutting heat

In our opinion, hospitals usually bear more than their fair share of blame when insurers make cuts to their health plan networks. To be fair, not every hospital is always in the… Read More

Are pharmacy benefit managers a prudent service – or a profit scheme?

Pharmacy business managers (PBMs) control the cost of prescriptions for patients. This might sound like a good thing – theoretically, by monitoring prescription costs, PBMs are supposed to increase access to necessary… Read More

Anthem and BlueCross BlueShield: A “whoopsies,” of sorts

In general, making a “whoopsie” is not terribly sinister. We can forgive the occasional mess-up. But for big insurers, when there’s a processing error, it’s a big deal. Case in point: Remember… Read More

UnitedHealthcare reconsiders pandemic underpayments

When it comes to underpaying for COVID-19 care, you almost can’t blame UnitedHealthcare for trying. Well, actually, we can. After providers, largely pediatricians, complained that United was paying them substantially below market… Read More

A royal flush of managed care mischief

Ohio, Mississippi, Arkansas, Illinois – and now, Iowa. By this point, you could probably tell the tale of misused state dollars as well as we can…but here we go again. In 2016,… Read More

More Medicaid trouble in Ohio

Today, we’re talking about “clawbacks.” And yes, they are as scary and painful as they sound. Before we explain what’s going down in the Buckeye State, here’s a refresher on PBMs. These… Read More

One PBM is taking the “special” out of “specialty care”

When it comes to specialty conditions such as HIV/AIDS, multiple sclerosis, rheumatoid arthritis, anemia, and even cancer, the “special” label that describes the condition, medication and care isn’t a meaningless label. These… Read More

We’ve got eyes on payors during negotiation season

Ah, fall. The temps are dropping, Thanksgiving is just around the corner, the Christmas holiday will be here before we know it, and… insurers are cutting hospitals out of their networks. Wait,… Read More

The big get bigger, but at whose expense?

It seems like the rollercoaster that never drops. As if you couldn’t guess, yes, we’re talking third-quarter earnings for two of the biggest insurers. Anthem and UnitedHealthcare saw a dramatic increase in… Read More

Did insurers get a “thumb on the scale” in the No Surprises Act?

Surprise bills, be gone! Spooky season may be over, but the holiday season is here, and we still hope there’s some magic left in the air to rid patients of surprise bills… Read More

Optum strikes its biggest hospital deal yet – but is it for the greater good?

We’ve said it before: Optum is getting bigger. A subsidiary of UnitedHealthcare, Optum has inked its largest health system deal yet, Healthcare Dive reports. After another successful quarter (if you’re a shareholder,… Read More

Do health insurance monopolies cause poor health?

Big Appliance. Big Oil. Big Dairy. Big Pharma. Annnnnd Big Health Insurer. Not that we needed more evidence to prove the big business of health insurance, but a recent article in Modern… Read More

Are anesthesiologists’ UnitedHealthcare contracts going under?

Anesthesiologists are in a painful situation, which is unfortunate considering their job is to help manage pain. In a recent article in Modern Healthcare, the American Society of Anesthesiologists (ASA) claims that… Read More

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