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Industry Control
Payors are taking control across the full continuum, advancing their business interests without providing real value to patients or their communities.
Doctors and patients are getting loud online. Here’s why.
North Carolina resident Sally Nix has had enough with prior authorizations. Afflicted with a combination of autoimmune diseases since 2011, brain and spinal surgeries failed to relieve Nix’s chronic pain and fatigue.… Read More
Another survey reveals the dark underbelly of commercial health insurers
Back in July, the American Hospital Association (AHA) released findings from three surveys conducted by Morning Consult on the practices of commercial health insurers. The findings weren’t great. Patients, nurses, and physicians… Read More
Prior authorizations are (still) a bad idea.
We’ve said it before, and we’ll say it again: Prior authorizations are a bureaucratic bad idea. At least, they are for physicians and patients. But while prior authorizations can be a minor… Read More
UnitedHealthcare rolled back its prior authorization policy. But ‘advance notification’ might be even worse.
Earlier this spring, UnitedHealthcare (United) announced plans to effectively use prior authorizations as blockades to colonoscopies. Any patient seeking a surveillance or diagnostic colonoscopy to detect cancer would first need approval from… Read More
Bad BCBSNC bill gets more time to become worse
Whoops, Blue Cross Blue Shield of North Carolina (BCBSNC) – you almost had us. The state’s largest health insurer is attempting to reorganize its business structure . . . which, conveniently, will… Read More
Hospitals attempt to stay afloat amidst nasty contract negotiations
Every few years, contract negotiations between payors and providers pull back the curtain on the innerworkings of the American healthcare system. The findings are gruesome. For reference, a recent article in Becker’s… Read More
TennCare’s convenient self-congratulations
To get a job done right, it’s often better to take care of it yourself. But that’s not necessarily the case for many states when it comes to health insurance coverage for… Read More
A deep dive into the risks of the UnitedHealth and Change Healthcare merger
What if there was an opportunity to make the biggest health insurance conglomerate in the United States even more powerful by equipping them with boatloads of sensitive health data? Imagine no more.… Read More
Sugar and spice, not everything’s nice…
It’s the holiday season, a time for peace and goodwill, right? Well, not quite. Because it’s also the season for contract negotiations, err . . . disputes. And it looks like insurers… Read More
Insurance competition keeps weakening
It’s ironic, isn’t it? When hospitals, who are on the verge of closure following a brutal pandemic, decide that partnering with other providers is the only way to keep their doors open,… Read More
Is it just us, or are claim denials on the rise?
Over the past year, hospitals across the nation have experienced a rise in denied medical claims from insurance companies. According to a recent article in Modern Healthcare, approximately 67% of healthcare leaders… Read More
Humana goes on a primary care spending spree
It’s been a while since we’ve talked about Humana. But this one is big. According to a September 2022 article in Fierce Healthcare, Humana is pumping $500 million into primary care clinics,… Read More
Break out your umbrella — we’ve got a payer forecast ahead.
Showers are forthcoming. Maybe even thunderstorms, by the look of it. According to a recent article in Becker’s Payer Issues, UnitedHealth Group (UHG) reported third-quarter revenue growth in the double digits across… Read More
More people are covered by health insurance – but health insurance covers less
Here’s the good news: The number of Americans with health insurance is hitting historic highs. And the bad news: The health insurance itself is inadequate. According to recent findings from the Commonwealth… Read More
Can the feds finally make mental health parity a reality? Here’s hoping…
The future of mental health coverage parity remains uncertain, according to a recent article from Axios. But it’s not for lack of trying. For the upcoming legislative session in February, the Senate… Read More
California governor shoots down bill to protect patient access
It’s an unfortunate ending for California patients – a utilization management bill successfully passed the state Assembly and Senate, just to be vetoed by Governor Gavin Newsom. Sponsored by California Assembly member Dr.… Read More
A picture’s worth a thousand words. For health insurers, it’s worth millions.
You know that $100+ premium you pay each month to ensure you have health insurance? Or maybe it’s more like $500+? For the really unlucky, it could even be $1,000+! Turns out,… Read More
With big premium bumps, Northeastern consumers may be facing a frigid financial future
We’re not saying we told you so, but we are saying we saw this coming. Health insurance premiums are up nearly 14%, and consumers across the States are already facing inflated insurance… Read More
Hospital outlooks? ‘Deteriorating.’ Payor predictions? ‘Attractive returns.’
Bad news for nonprofit hospitals (and just after things were maybe looking up!). Ratings agency Fitch Ratings published a new outlook for the nonprofit hospital sector, and it’s anything but encouraging. In… Read More
We’ve made it another half-year. Guess which health insurer is in the lead (again).
We’ve made it another half-year. Guess which health insurer is in the lead (again). Another earnings season, another unfathomably large profit for our nation’s largest health insurance company (and the rest aren’t… Read More
Hospitals may catch a break in insurer negotiations (but we’re not holding our breath)
Dare we say we have . . . good news? Could it be that payers are finally acknowledging how expensive it is to operate a hospital? According to a recent article in… Read More
Insurance contract disputes: when the odds are not in patients’ favor
They say all’s fair in love and war. Well, not when it comes to health insurance contract disputes. At least, such is the case for one local community in California. Adventist Health… Read More
Health insurers don’t want to cover your care—their chronic denials prove it
In 2020, amid a global pandemic, health insurers on the Affordable Care Act marketplaces denied close to one-fifth of all in-network claims, according to a Healthcare Dive article citing Kaiser Family Foundation… Read More
Optum takes its joint ventures to the next (vertical) level
Is there any type of business that health insurance giant UnitedHealth Group won’t try to stick a flag in? Per a July 11 article in Modern Healthcare, UnitedHealth’s massive physician group, Optum,… Read More