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United adds another claim denial to their line-up: behavioral health

“Not allowed to retroactively deny emergency department (ED) claims? Well, then we just won’t pay out-of-network (OON) claims anymore.” We imagine this was idea that got thrown out at the latest meeting… Read More

CMS’ surprise billing rule puts United on the defense

As you know, UnitedHealthcare recently laid out its plan to put in place a policy allowing them to retroactively deny emergency department visits if the treatment shows it wasn’t an actual life… Read More

Is United the fox guarding OptumRx’s hen house?

Remember how a few months ago we wrote about how pharmacy benefit managers (PBMs) are huge benefactors for profit growth within insurers (ahem, Anthem)? Well, it’s becoming a trend that keeps ascending for… Read More

In-network providers: now you see them, now you don’t

“Come join our health plan—look at this huge list of in-network providers! Scroll through the directory and check out the breadth of our coverage! Just sign here.” Sounds like a good deal,… Read More

United’s proposal to raise rates has Rhode Island raising an eyebrow

Here’s what we’re wondering: Is there really a tsunami of patients set to crash down on the healthcare system as the pandemic dies down? Here’s what (we think) health insurers are wondering:… Read More

A Blue Cross Blue Shield venture sparks concern

A new business dedicated to reducing the high cost of prescription drugs and curbing needless drug spending? Sure, we’re all for it. Setting up that business so that the health insurance investors… Read More

The terminator

United and two non-profit hospitals in Georgia’s Gwinnett County Northside Hospital system have parted ways. United accused Northside of “padding its bottom line at the expense of its patients,” while Northside took… Read More

United announces plans to deny ED claims retroactively

Let’s say you have a pain somewhere in your gut in the middle of the night. You’re not sure where it came from; it gets worse and then better, but it’s not… Read More

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

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