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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

News flash: North Carolinians don’t trust their health insurance provider.

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

This year, insurers are pulling record-breaking profits. Next year, you’ll pay them even 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

Who will fight the insatiable Medicare Advantage ‘cash monster’?

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

Insurers keep winning as the healthcare profit gap widens

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

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

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

Put up your dukes. Insurers are coming out swinging.

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

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

Another way insurance regulation benefits health insurers — not patients

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

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

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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.