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Aetna just cut Walgreens from its Medicaid plan in Illinois

Ever since the CVS/Aetna deal closed in late 2018, we’ve been tracking how the merger of a major insurer with a pharmacy and healthcare services giant will impact the choices individuals with… Read More

Centene expands into behavioral health with a $2.2B acquisition, just weeks after dipping further into pharma

On January 4, 2021, Centene announced a definitive agreement to acquire Magellan Health, an insurer with a vast behavioral health network, for $2.2 billion. Centene claims that in light of the pandemic,… Read More

UnitedHealthcare just cut thousands of emergency room docs from their 2021 network

We rang in 2021 with yet another big move by UnitedHealthcare: its decision to cut Envision Healthcare from its network after the two companies were unable to come to an agreement regarding… Read More

CMS is pushing payors to improve prior authorizations processes

It looks like prior authorizations—or more specifically, the myriad challenges providers face around prior authorizations—are becoming an Un-covered theme. If you’ve been following our feed, you’ll recall that we recently shared our… Read More

Hospital claim denials are on the rise, especially those related to prior authorization issues

According to RevCycle Intelligence, a new survey of 200 hospitals conducted by the American Hospital Association (AHA)—and supplemented by interviews and group discussions with several hundred additional hospital and health system executives—found… Read More

United kicks off 2021 by cutting a critical NYC safety-net health system from its network as COVID-19 cases reach record highs

Here’s a trend we saw in 2020 and will likely continue to see in 2021: UnitedHealthcare forcing providers to choose between accepting dramatic pay cuts or being cut out of United’s network.… Read More

Consumers seeking comprehensive coverage should watch out for this predatory United health plan 

When Sam Bloechl was buying a comprehensive health plan, one he believed would cover him for a life-threatening illness; he did not know he was sick. A subsequent cancer diagnosis led doctors… Read More

Survey indicates COVID-19 pandemic adding to insurance cost burdens

A new survey from The Commonwealth Fund (reported on in Healthcare Dive) brings more bad news from the ongoing COVID-19 pandemic. The survey confirms what we already knew—that insurance premiums and deductibles… Read More

Public opposition to new lab coding policy pushes UnitedHealthcare to hit pause

Back in November, we covered a Health Leaders story about a new lab coding requirement UnitedHealthcare planned to implement in early 2021, smack in the middle of cold and flu season and… Read More

Here’s what members and employers need to get more from the health insurance industry

Health insurance has always been a highly valued employee benefit, and now in the midst of the COVID-19 pandemic, it is even more true. Access to healthcare, including access to health insurance… Read More

UnitedHealthcare squeezes Gaston County’s only hospital during worst pandemic months

Residents of Gaston County with UnitedHealthcare insurance are expected to face higher costs at Gaston County’s only hospital, CaroMont Regional Medical Center. This is due to UnitedHealthcare terminating their CaroMont Health contract.… Read More

Over 30 hospitals have been forced to file for bankruptcy this year

2020: the year COVID-19 flipped the world upside down. COVID-19 continues to have a disproportionately detrimental impact on the healthcare industry, as pre-COVID-19 many hospitals were already struggling. Even before the global… Read More

New research shows just how hard it is for consumers to understand their insurance options

It’s open enrollment season again, which means that employees across the country are assessing the insurance options offered by their employers and trying to understand which plan will offer the most value… Read More

UnitedHealthcare ordered to reprocess 67,000 behavioral health claims

Back in October, we shared a Bloomberg article about insurers violating the spirit of the The Mental Health Parity and Addiction Equity Act. At the center of this story was a lawsuit… Read More

Cigna accused of fraudulently overbilling Medicare Advantage plans

In August, the complaint in a federal whistleblower lawsuit against Cigna was unsealed. In it, Cigna is accused of collecting billions of dollars in overpayments from its HealthSpring Medicare Advantage plans. How… Read More

What if a COVID-19 diagnosis could be used against health plan members?

If the ACA is struck down by the Supreme Court, the protection it provided for people with pre-existing conditions will no longer exist. Insurers will go back to being able to charge… Read More

As virtual doctor’s visits rise in popularity, major health insurers change the rules

Up until COVID-19 hit, utilization of virtual care was extremely low. Most people had never tried telehealth; some weren’t even aware that they could connect with doctors and nurses from their phones… Read More

United piles on more coding to already exhausted and overwhelmed providers

In September, UnitedHealthcare released a plan that will require all in-network freestanding and outpatient lab claims to include a unique code for testing services. This code is in addition to existing standard… Read More

Health insurance doesn’t assure you of anything in the U.S.

Why does anyone buy health insurance? To ensure they have access to the healthcare services they and their families need. Unfortunately, having coverage today doesn’t always mean care is covered, nor does… Read More

Health insurers stockpile savings while hospitals battle costly pandemic

During the COVID-19 pandemic, hospitals and health systems have fully embraced their role in responding to the public health crisis, moving mountains to offer community testing services and providing care for patients… Read More

Oops! Blue Cross Blue Shield of Texas pays big for billing mistakes

This March, after state investigators determined that Blue Cross Blue Shield of Texas had made major billing mistakes related to out-of-network emergency claims, the insurer agreed to pay a $10 million fine… Read More

Americans fight insurers for mental health coverage as suicide is on the rise

The Mental Health Parity and Addiction Equity Act, passed more than a decade ago, requires insurers to cover mental health care in a way that is comparable to other medical treatments. Yet,… Read More

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