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Patients in limbo as Cigna splits with a health system

On May 30, health insurer Cigna ended its contract with Virginia-based Mary Washington Healthcare. The reason it states is a failure of the two parties to come to terms on charges and… Read More

Can the new kid on the block make it?

Who is Centene, you may ask? This brazen health insurer shot up seemingly out of nowhere (well, Wisconsin) to become a significant player in the market, with annual revenues (and vertical integration… Read More

A closer look at Optum, United’s fastest growing business

We talk a lot about Optum in terms of its place in the UnitedHealth Group family tree, and how it fuels its parent company United’s growth. But a recent piece in Fierce… Read More

The feds take a closer look at mental healthcare coverage

To set the stage, let’s look at how things were before the pandemic. A recent report by the Government Accountability Office (GAO) paints a picture of a behavioral health system that was… Read More

What happens when insurers take the doctor out of the equation?

In a recent article, Modern Healthcare shared some of the repercussions of a growing trend: health insurance companies taking patients’ pharmaceutical care from doctors. It’s clear that insurers can reap massive financial… Read More

There’s big money in those PBMs

The stats on the expansion of IngenioRx, Anthem’s pharmacy benefit manager (PBM), are hot off the presses—and the numbers are big. To help put them in context, here’s a quick primer on… Read More

Evernorth’s high-rise portfolio gains another story

On April 20, Healthcare Dive updated a story we’ve been following about the acquisition of telehealth company MDLive by Evernorth, the recently re-branded primary health services umbrella group of Cigna. The Dive story… Read More

Megabucks for managed care

A massive arrangement has been reached between Ohio and six insurance companies hired to coordinate Medicaid managed insurance for more than 3 million low-income and/or disabled state citizens. It’s set to go… Read More

Death by 1,000 prior authorizations

Providers hoping to treat their patients with radiation therapy may want to add some extra hours to their billing departments’ budgets. (And while they’re at it, they might consider prescribing them some… Read More

“Information wants to be free”

So, here’s a clever way to bolster an insurance company’s annual profit report: Charge physicians to access claims payment data. Sound crazy? Well, that’s what UnitedHealthcare was doing, until recently, through its… Read More

It’s 2021: Do you know where your personal data is?

Earlier this year, UnitedHealth Group’s Optum subsidiary bought itself a present: the data analytics firm Change Healthcare, which is a massive administrative network that processes claims and pharmacy requests for physicians and… Read More

Telehealth has been a saving grace during the pandemic. Will insurers let it continue?

As a post-pandemic future takes shape, many of us are anxiously waiting to see how telehealth will be treated in upcoming contract hospital-insurer negotiations. Some analysts predict that hospitals are going to… Read More

Insurers edge physicians out of the medication process

This isn’t the first time the American Hospital Association (AHA) has flagged insurance company policies that take decisions regarding patient care away from the physicians they know and trust. Just recently, we… Read More

Why Medicaid contracts worth $2.1 billion shouldn’t go to private insurers

As we recently noted, the Oklahoma Health Care Authority (OHCA) decided to shift management of its Medicaid business to four for-profit health insurance companies, including UnitedHealthcare, in a deal estimated to be… Read More

Unhappy birthday: An esoteric bit of insurance legalese throws new parents into six-figure debt

As we like to point out having health insurance doesn’t mean that you’re actually covered. While this plays out in any number of frustrating (and dare we say, dubious) ways every day, here’s… Read More

Miserly coverage for COVID-19 testing for children puts pediatricians in a no-win situation

In October, we shared a story about insurers actively blocking access to care and refusing to fully cover COVID-19 tests. Now, there are reports of insurers denying coverage for kids while passing the… Read More

Legislators push to prevent a sudden loss of telehealth services after COVID-19

One of the few upsides of the COVID-19 pandemic has been the rapid rise of telehealth. In the past, federal legislation has limited Medicare coverage for telehealth, but thanks to policy changes… Read More

Oklahoma moves state Medicaid business to these 4 for-profit insurers

Oklahoma Governor Kevin Stitt announced the state is moving its Medicaid business to 4 for-profit healthcare companies: Blue Cross Blue Shield of Oklahoma, Humana Healthy Horizons, Oklahoma Complete Health (a subsidiary of… Read More

Top payor-provider trends to be on the lookout for in 2021

If we had to use one word to describe 2020, it would be “change,” and that’s particularly true in healthcare. Now that we’re several weeks into the new year (that was fast!),… Read More

Did Cigna take advantage of a surge in COVID-19 hospitalizations to deny claims?

New York resident Dinah Nissen was bitten on her right cheek by a dog in mid-May. After a clinician at a local urgent care urged her to see a plastic surgeon immediately,… Read More

More than 500 rural hospitals at risk for closure before pandemic hit

Stories of rural hospitals being forced to shutter their doors because of financial strain are unfortunately becoming more and more commonplace, but this latest data from the Center for Healthcare Quality and… Read More

The AHA flags new UnitedHealthcare policies for federal scrutiny

Two new seemingly unrelated policies being rolled out by UnitedHealthcare—one on labs and the other on specialty drug distribution—have been flagged by the American Hospital Association (AHA) as problematic for the same… Read More

Blues plan switches to a United-owned PBM

Blue Cross Blue Shield of Michigan and Blue Care Network recently announced they are switching from Express Scripts (owned by Cigna) to OptumRx (owned by UnitedHealth Group) with the intention of reducing… Read More

CMS approves new rule aimed at easing the burdens around prior authorizations

Despite strong pushback from health insurers, The Centers for Medicare & Medicaid Services (CMS) went ahead and finalized a rule, first proposed in late 2020, that is aimed at regulating the industry.… Read More

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