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Insurer policies limit coverage and disrupt patient care, while producing record profits for corporate shareholders. Stay informed with the Un-covered newsletter.
Care and Access
Payors create administrative burdens and restrictive policies that prevent patients from accessing care and block providers from delivering it.
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
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