Skip to Content

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

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

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

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

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

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

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

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

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

You get a bill, you pay it. Right? Not these two top health insurers…

A pair of insurers have yet to pay their bills, and we aren’t talking chump change. Provider representatives say the insurers are billions of dollars behind on payments owed to hospitals and… Read More

More ghost networks, just in time for Halloween

Another ghost network story is giving us chills. A new whistleblower case reported in Modern Healthcare, alleges Aetna illegally secured contracts with Pennsylvania’s Medicaid program, HealthChoices, by misrepresenting the number of pediatricians… Read More

Is United penny-pinching pediatricians?!

UnitedHealthcare is known for denying coverage. Old story, we know. But now, they’ve targeted pediatricians. Seems a little aggressive, right? The American Academy of Pediatrics (AAP) seems to agree, and they aren’t… Read More

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

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

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

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

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.

Un-covered on Twitter

Subscribe to Un-covered Essentials

Your payor relations plan is only as good as your knowledge of industry trends—stay informed with our bi-weekly newsletter.