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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

Hey North Carolina, where’s the outrage on insurance increases?

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

No kidding: Americans dissatisfied with health insurance plans

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

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

Connecticut AG pushes back on health plan premium hikes – again

Summer in New England is quite nice – our Northeastern friends often enjoy somewhat cooler temps than the rest of the country. Unless you’re an insurance plan, in Connecticut. Then you’re (appropriately)… Read More

Will new federal rules bring health insurers’ shady negotiation tactics to light?

It’s finally here – after wrangling substantially more time to prepare than hospitals had, insurers are now required to post their negotiated prices publicly on their websites. According to Fierce Healthcare, the… Read More

Just how profitable have health insurers been in the last few years?

If you’ve been reading Un-covered for a while, you’re probably well aware that health insurers have been extremely profitable in the last few years. Even so, new information continues to demonstrate just… 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

Can you guess which health insurer has a history of tax breaks?

Benjamin Franklin once said, “Nothing is certain except death and taxes.” Well, apparently, not true for Blue Cross Blue Shield (BCBS). According to a new report from STAT News, many BCBS plans… Read More

American Hospital Association begs feds to enforce the law

According to a recent article in Fierce Healthcare, in late May the American Hospital Association (AHA) published a letter to the Department of Justice (DOJ) pleading for an investigation “into commercial payers… Read More

That ‘no-name’ drug in your cabinet? It may not be saving you as much as you think.

Let’s face it: the only reason we buy generic goods is to save money. (And when it comes to healthcare, there’s a lot that inevitably needs to be saved.) This is especially… 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

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

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