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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.
Lawsuits
Payors are masters at maneuvering the legal system to advance their dominance of healthcare—suing any entity that gets in their way, defending themselves in anti-trust and other lawsuits, and paying millions in secret settlements.
Premium dollars or lives? For BCBSNC, we’re not sure there’s a difference.
Blue Cross Blue Shield of North Carolina has been booted . . . from the state health plan, that is. For decades, hundreds of thousands of North Carolinians have been getting their… Read More
No surprises here: Insurers failing to uphold their end of the No Surprises Act
It seems simple: Established in 2022, the No Surprises Act seeks to limit the amount of out-of-pocket expenses that patients might get stuck with when their insurance company is out of network… Read More
Another algorithm to say ‘no’ to your care
Nice try, UnitedHealthcare . . . The nation’s largest health insurer has recently found itself in hot water over an algorithm it uses to deny rehabilitation care for Medicare Advantage beneficiaries. According… 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
News flash: your health insurer thinks it knows more than your doctor
“Not medically necessary.” Says who…a doctor? No…an insurance company. And the insurance company here isn’t just any insurance company: we’re talking about UnitedHealthcare, the largest insurance company in the country. A company… Read More
Despite millions in settlements, Centene’s doing just fine
In case you’re not up to speed on the drama, managed care organization Centene is no stranger to legal settlements. We call it ‘managed care mischief’ — when a private company is… Read More
No surprises here: Another suit alleges insurers have the upper hand in claims disputes
Maybe in 2023, the federal government will employ a fair way to settle billing disputes between hospitals and insurance companies. But with the Texas Medical Association (TMA) filing its third lawsuit this… 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
It’s another legal loss for UnitedHealthcare
It’s another loss for UnitedHealthcare (United) in its ongoing legal battle with TeamHealth. The Tennessee-based emergency physician company has filed a total of ten lawsuits against UnitedHealth Group, but its most recent… Read More
Anthem is heading to court (again)
The artist formerly known as ‘Anthem’ can’t escape its legal woes. You may remember back in 2020 when the health insurer paid $594 million toward the Blue Cross Blue Shield Association antitrust… Read More
Need medical care? Better prove it.
We all (unfortunately) know that getting your care covered by insurance is anything but simple. And for families with children with autism spectrum disorder, insurers like Trustmark Health Benefits make the process… Read More
Another prior authorization delays patient care and ends in tragedy
OK, we admit it. We’re (fairly) snarky when it comes to health insurance companies. But there’s no room for snark when it comes to a recent Medscape article, which follows the journey… Read More
TeamHealth and UnitedHealthcare get in the ring . . . again
Does a Nevada lawsuit with UnitedHealthcare (United) sounds familiar? Well, since TeamHealth filed ten lawsuits against UnitedHealth Group last December, alleging underpayment for TeamHealth physicians – it might! In the first case,… Read More
‘No-fault’? Yeah, right. Centene’s foibles are starting to add up
It’s been a while since we’ve done a good ‘ole update in our series, Managed Care Mischief. But not to worry — we’re back and headed to New Mexico, where Centene, known… Read More
For Anthem, a rose by any other name . . .
Drumroll, please. Because later this month, Anthem will become … wait for it: ‘Elevance Health.’ This is the health insurance company’s second rebrand in a decade, and you’re not alone in wondering… Read More
It’s time for another contract dispute round-up
Are insurer contract disputes ‘business as usual’? A recent Becker’s Payer Issues article rounds up eight recent disputes between health plans and hospitals — from Maine to Mississippi, Colorado to Georgia, and… Read More
UnitedHealthcare’s ‘evil empire’ strikes back against a new lawsuit
Break out the popcorn for this one. According to a recent article in HealthLeaders, UnitedHealthcare has found itself in yet another legal battle. United is no stranger to being sued and at… Read More
Reading between the lines in the latest hospital/health plan split
The separation of a Maine hospital from one of the nation’s biggest health insurers speaks to an overarching pattern: the unending blame game of health insurers.
The good times may be coming to an end for UnitedHealth Group
Yet another lawsuit for this Big Insurer over its subsidiaries’ sketchy Medicaid behavior, this time in laid-back Louisiana
Did a recent ruling in the Lone Star State embolden BCBSNC’s abuse of the No Surprises Act?
What’s that old phrase? “The road to hell is paved with good intentions”? As it turns out, the No Surprises Act is living proof that, no matter how much the federal government… Read More
UnitedHealthcare’s tactics aren’t so bright in the Sunshine State
It’s time to roll out the insurer red carpet – straight to court! According to an article in the Orlando Sentinel, UnitedHealthcare (United) recently shelled out more than $4.7 million to UF… Read More
Centene and the settlement saga
“Centene” and “settlement” are two words that have come up so many times this year, we can’t even count. And it’s not stopping yet. Another million-dollar settlement is on the table for… Read More
The (first) jury is in, and UnitedHealthcare takes the hit
The jury has deliberated; the gavel has landed, and an insurance company is forced to face the repercussions of its actions. According to a recent article in Modern Healthcare, Tennessee-based emergency physician company… Read More