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Aetna members might need to start sleeping with one eye open

Vision can be an overlooked element of health. But not for Aetna, who launched a new policy requiring prior authorization for all cataract surgeries as of July 1. Per a recent article… 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

Top insurers are pushing for a (not-so-even) swap in medications

Many would argue that Coke is not the same as Pepsi, yet the taste is close enough that they could swap if the other was unavailable. When it comes to prescription drugs,… Read More

Playing payor Whac-A-Mole

The fun never ends when it comes to protecting patients from unfair out-of-network charges, per a July 30 Becker’s Review article.

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.

Still riding that health insurer merry-go-round

You pay for insurance to help pay for healthcare, which includes your prescription medications. So, what happens when they stop covering those expenses? That’s exactly what 85-year-old Juanita Freeman’s was surely asking… Read More

Another day, another telehealth coverage battle

And the telehealth saga continues. As we’ve said before, the COVID-19 pandemic opened many doors (even apps) for telehealth. Specifically, being able to provide patients access to care without going into the… Read More

When it comes to denying coverage, United’s like the Energizer Bunny… it never stops

We’ve covered a conglomeration of bad behavior from UnitedHealthcare – actions that many think negatively impact patients and providers alike, all in the name of profits. Now, we have a new ally… Read More

United adds another claim denial to their line-up: behavioral health

“Not allowed to retroactively deny emergency department (ED) claims? Well, then we just won’t pay out-of-network (OON) claims anymore.” We imagine this was idea that got thrown out at the latest meeting… Read More

CMS’ surprise billing rule puts United on the defense

As you know, UnitedHealthcare recently laid out its plan to put in place a policy allowing them to retroactively deny emergency department visits if the treatment shows it wasn’t an actual life… Read More

Is United the fox guarding OptumRx’s hen house?

Remember how a few months ago we wrote about how pharmacy benefit managers (PBMs) are huge benefactors for profit growth within insurers (ahem, Anthem)? Well, it’s becoming a trend that keeps ascending for… Read More

In-network providers: now you see them, now you don’t

“Come join our health plan—look at this huge list of in-network providers! Scroll through the directory and check out the breadth of our coverage! Just sign here.” Sounds like a good deal,… Read More

Is BCBS stealthily stifling competition?

Remember when we covered the $2.67 billion class action suit against several Blue Cross Blue Shield (BCBS) plans in Michigan and the claims accusing them of price-fixing to squelch competition? We noted… Read More

United’s proposal to raise rates has Rhode Island raising an eyebrow

Here’s what we’re wondering: Is there really a tsunami of patients set to crash down on the healthcare system as the pandemic dies down? Here’s what (we think) health insurers are wondering:… Read More

United members expect coverage for post-cancer surgery. United says: “Nah.”

So, let’s say a woman you know is diagnosed with breast cancer, and with the right healthcare, she beats it. It’s a tough fight, but she beats it. Everybody breathes a sigh… Read More

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

A Blue Cross Blue Shield venture sparks concern

A new business dedicated to reducing the high cost of prescription drugs and curbing needless drug spending? Sure, we’re all for it. Setting up that business so that the health insurance investors… Read More

CA doctors accuse United of shortchanging them on COVID-19 tests

The latest in the saga of United’s ascent to the peak of Mt. Miserly is the case being brought against them by the California Medical Association (CMA). As reported by Healthcare Dive,… Read More

Humana’s latest home care acquisition

Health insurer Humana is on an acquisition roll, bringing yet another home health care provider into its fold. They just snarfed up One Homecare Solutions, which goes by Onehome, for an undisclosed… Read More

Louisiana bags white-bagging

How about a bit of good news, for a change? Modern Healthcare ran a story about how Louisiana passed legislation ruling that insurers can no longer bypass hospitals’ in-house pharmacies in favor… Read More

Aetna: keeping it class(action)y

Do you ever wonder whether some insurers may simply have chosen the wrong line of work? The basic exchange in health insurance entails receiving money from people who want their healthcare needs… Read More

The terminator

United and two non-profit hospitals in Georgia’s Gwinnett County Northside Hospital system have parted ways. United accused Northside of “padding its bottom line at the expense of its patients,” while Northside took… Read More

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