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Another slam dunk for UnitedHealthcare

An unfortunate reality in this country is that many Americans struggle to access and pay for healthcare. The reasons are varied, and different stakeholders cast blame differently: Hospital  prices. Decreased Medicaid reimbursement.… Read More

Patients over profit: How rural maternity units are barely hanging on

Losing a maternity unit is not just bad for the health of OB-GYN patients, but for the health of the hospital. Can rural hospitals safely deliver babies when reimbursements keep dropping?

Health plans put the squeeze on Medicare Advantage

For health insurers, the Medicare Advantage (MA) cup is definitely not half empty. In fact, the cups runneth over as insurance companies seem to squeeze as much as they can from the… Read More

Pretty pandemic pennies for BCBSNC

The pandemic’s been kind to BlueCross BlueShield of North Carolina (BCBCNS), according to 2021 financial reports. Revenue? Up. Profits? Up. Executive bonuses? Well, up, of course, to the tune of an extra… Read More

For BCBSNC, COVID costs are up – but so are profits

If anyone in healthcare could say they actually benefited from COVID-19, it was health insurance companies. Don’t get us wrong – there were bills for health plans to pay. According to a… Read More

The Three Worst Insurance Trends of 2021

Insurance companies sure found plenty of creative ways to make money in 2021. Some we expected, some were new, and many made it harder for patients to access the healthcare services they… Read More

Seeing beyond the peak of UnitedHealthcare’s revenues

No mountain is too high when it comes to revenue expectations for UnitedHealthcare. 2020 was good, 2021 was better, and in 2022, we can’t even see the peak yet. Per a recent… Read More

Are pharmacy benefit managers a prudent service – or a profit scheme?

Pharmacy business managers (PBMs) control the cost of prescriptions for patients. This might sound like a good thing – theoretically, by monitoring prescription costs, PBMs are supposed to increase access to necessary… Read More

More Medicaid trouble in Ohio

Today, we’re talking about “clawbacks.” And yes, they are as scary and painful as they sound. Before we explain what’s going down in the Buckeye State, here’s a refresher on PBMs. These… Read More

The big get bigger, but at whose expense?

It seems like the rollercoaster that never drops. As if you couldn’t guess, yes, we’re talking third-quarter earnings for two of the biggest insurers. Anthem and UnitedHealthcare saw a dramatic increase in… Read More

You get a bill, you pay it. Right? Not these two top health insurers…

A pair of insurers have yet to pay their bills, and we aren’t talking chump change. Provider representatives say the insurers are billions of dollars behind on payments owed to hospitals and… Read More

Breaking news for the DHHS…but not for us

Finally, at (very) long last, the Department of Health and Human Services (DHHS) is putting the many pieces of Medicare fraud together. An exclusive report in the Wall Street Journal explains that… Read More

Is this mic on? We’ve been looking for some clarity on record-breaking profits for insurers

We interrupt our regular programming to take you back to Connecticut, where insurance scrutiny remains high. Which, if we’re being honest, is our regular programming. Just last week, we covered the Connecticut… Read More

(Some) states push back on rate increases—finally!

It’s that time of year. No, not just for pumpkin spice lattes, but for health insurers to petition state Departments of Insurance for the next year’s rate increases. Everybody, brace yourselves. Each… Read More

Two trips to space, or roughly $11B. That’s how much insurers profited in Q2 this year

Drum roll, please. It’s earning season once again and, sure enough, five of America’s largest health insurers cleaned up in Q2. We’re not just talking “cleaned up”—we’re talking bleached, waxed, and wiped… Read More

UnitedHealthcare is hitting pre-pandemic profit records…yippee.

It’s common knowledge at this point – insurers made a killing last year due to the pandemic. Limited care led to fewer medical claims, which led to more dollars in insurers’ pockets.… Read More

The “insurer” will see you now

UnitedHealthcare’s profits seem to correlate with how much control they have over the industry, and according to a July 16 article in Axios, it’s more than we previously thought.

Up, up, and away: Anthem’s expectations for membership growth soar

Despite an already impressive growth in membership, Anthem is adding more to its expected year-end goals, reports a July 21 article in Healthcare Dive. Wondering how? Us, too!

The double-team PBM scheme from Anthem and Humana

What happens when two top insurers team up together to take over the PBM world? A July 26 article in Insider Intelligence has us wondering.

Humana’s latest purchase morphs into a sale

We’re feeling a bit buffeted by multiple aftershocks here. Humana’s chess pieces just keep sliding around the board. First, the insurer snapped up full ownership of Kindred at Home, the biggest home… Read More

Payor? Provider? Insurance industry lobbyist gets less clear

When Kentucky Fried Chicken changed its name to KFC there was little doubt in anyone’s mind that they were still serving up classic deep-fried poultry. But according to the company, the rebranding… Read More

Is a year’s worth of pent-up medical care about to hit?

As the COVID-19 pandemic upended our lives over the past year, many people delayed aspects of their medical care and postponed elective procedures. But now that the country is starting to open… Read More

While its front end dips, the rest of CVS’ business soars

CVS Health’s vertical healthcare model is proving lucrative—and to us, is starting to look dauntingly powerful. As you may know, the company owns an international string of pharmacies, a pharmacy-benefit manager and—the… Read More

A new diagnosis: Munchausen syndrome by payor?

We’ve heard of Munchausen syndrome by proxy, but Anthem’s latest billing snafu has us wondering if a new diagnosis is in order — Munchausen syndrome by payor. A report by the Office… Read More

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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.