Evidence

Residents of Gaston County with UnitedHealthcare insurance are expected to face higher costs at Gaston County’s only hospital, CaroMont Regional Medical Center. This is due to UnitedHealthcare terminating their CaroMont Health contract.… Read More

New Jersey’s largest health insurance company, Horizon, says that a corporate restructuring will allow it to better invest in technology, build partnerships, and cut costs of care. Patient advocates say it’s an… Read More

2020: the year COVID-19 flipped the world upside down. COVID-19 continues to have a disproportionately detrimental impact on the healthcare industry, as pre-COVID-19 many hospitals were already struggling. Even before the global… Read More

It’s open enrollment season again, which means that employees across the country are assessing the insurance options offered by their employers and trying to understand which plan will offer the most value… Read More

In summer 2020, nonprofit watchdog The Leapfrog Group surveyed more than 170 employers on their satisfaction with health plans’ responsiveness, transparency, payment reform, and value. When asked to grade their health plan… Read More

Recently, we covered an article by HealthcareDive that discussed Optum’s advantage in vertical integration in the health insurance industry. While there is no question that Optum continues to lead the pack, we… Read More

Life as we knew it completely changed in March, when the country began navigating the new normal of living in a pandemic. The novel coronavirus completely dominated the spring news cycle, and… Read More

Back in October, we shared a Bloomberg article about insurers violating the spirit of the The Mental Health Parity and Addiction Equity Act. At the center of this story was a lawsuit… Read More

It’s not uncommon for health insurance executives’ massive annual compensation packages to make the news, and 2019 was no exception. Last year, six health insurance CEOs received an excess of $15 million… Read More

In August, the complaint in a federal whistleblower lawsuit against Cigna was unsealed. In it, Cigna is accused of collecting billions of dollars in overpayments from its HealthSpring Medicare Advantage plans. How… Read More

If the ACA is struck down by the Supreme Court, the protection it provided for people with pre-existing conditions will no longer exist. Insurers will go back to being able to charge… Read More

The 2017 acquisition of DaVita Medical Group by UnitedHealthGroup had impacts across the country, but the strongest opposition to the deal came from the Colorado State Attorney General Phil Weiser, who took… Read More

Up until COVID-19 hit, utilization of virtual care was extremely low. Most people had never tried telehealth; some weren’t even aware that they could connect with doctors and nurses from their phones… Read More

Many articles that call attention to insurers’ huge profits during the pandemic have singled out UnitedHealthcare, but United is not the only payor to see profits rise as a result of delayed… Read More

In September, UnitedHealthcare released a plan that will require all in-network freestanding and outpatient lab claims to include a unique code for testing services. This code is in addition to existing standard… Read More

Occasionally, insurers determine that they have overpaid providers for care given to their plan members. Sometimes providers determine they have been underpaid by payors for care given to plan members. With a… Read More

Why does anyone buy health insurance? To ensure they have access to the healthcare services they and their families need. Unfortunately, having coverage today doesn’t always mean care is covered, nor does… Read More

During the COVID-19 pandemic, hospitals and health systems have fully embraced their role in responding to the public health crisis, moving mountains to offer community testing services and providing care for patients… Read More

Despite having offered what it characterizes as “extensive” financial assistance to its policyholders throughout the pandemic, UnitedHealthcare’s profits remain substantial nine months into the country’s battle with COVID-19. The Los Angeles Times… Read More

With all the vertical integration that’s happened across the insurance industry over the past decade, it’s not surprising that Optum sometimes gets lumped in with Aetna/CVS, Cigna/Express Scripts, and a series of… Read More

This March, after state investigators determined that Blue Cross Blue Shield of Texas had made major billing mistakes related to out-of-network emergency claims, the insurer agreed to pay a $10 million fine… Read More

The Mental Health Parity and Addiction Equity Act, passed more than a decade ago, requires insurers to cover mental health care in a way that is comparable to other medical treatments. Yet,… Read More

After posting a record $6.6B in profits for Q2—coinciding with the first wave of the COVID-19 pandemic—the industry giant saw profits drop in Q3 to $3.2B. Why? Because hospitals resumed both elective… Read More

In early 2018, it was announced that Cigna, one of the top five health insurance companies, had purchased Express Scripts, the last major independent pharmacy benefit manager, for $52 billion. The merger… Read More