Profits

Let’s say you run a big, unwieldy, expensive government program. You want to trim costs, but your program provides services in all 50 states for more than 65 million Americans, and you… Read More

It’s that time of year again . . . insurers across the country are starting to release their 2024 rates. It’s also that time of year again when insurers deflect their rate… Read More

If there’s one thing you can count on in the American healthcare system, it’s claim denials. At least, that’s what the research tells us. According to a recent Kaiser Family Foundation (KFF)… Read More

Insurers will do just about anything to make a buck. Including taking money owed to physician practices and hospitals. According to an article from ProPublica, insurers take cuts from physician reimbursements if… Read More

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

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

Ever wonder how hospitals and doctors’ offices get paid for the services they provide? Many of us know that insurers pay for some of the care patients receive, but how does a… Read More

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

Almost anyone can relate to or identify with the terms, ‘projection’ and ‘deflection’ — the experience of projecting your thoughts, feelings, and insecurities onto another person, and deflecting the blame away from… Read More

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

According to a recent poll conducted by Raleigh-based Meredith College, most North Carolinians don’t believe their health insurance provider has their best interest in mind. For some of you, this might seem… Read More

Brace yourself: Health insurance prices will be higher next year. Word on Wall Street is that health insurance companies are set to raise prices next year faster than medical costs are increasing,… Read More

According to a recent article in the New York Times, by next year, half of Medicare beneficiaries will have a privately operated Medicare Advantage (MA) plan. Seems innocuous enough. But wait, there’s… Read More

That payor-provider gap? It’s becoming an abyss. At this point, it’s clear that the U.S. healthcare system is simply breaking down — with billions of dollars being funneled toward insurance company shareholders,… Read More

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

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

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

Contract negotiations are nothing new – hospitals and insurance companies renegotiate their rates for services regularly. But the trend of the last few years is upped aggression from payors, where networks are… Read More

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

We’ve written many times about how profitable Medicare Advantage plans have been for insurance companies. In part, it seems because they are excellent at taking regulations intended to benefit consumers and managing… Read More

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

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

Only in the insurance industry can a business secure a $500 million-dollar profit and demand that consumers pay more. According to a September 1 article published in North Carolina News, Blue Cross… Read More

Well, well, well . . . if it isn’t the pot calling the kettle black. A new poll revealed that most American consumers are dissatisfied with their health insurance plans. You don’t… Read More