Evidence

FINALLY! North Carolina expanded Medicaid. After years of debate across the state, after months of pushing and pulling on both sides of the aisle, North Carolina Republicans finally passed Medicaid expansion. It’s… Read More

1.2 seconds. That’s how long it takes for ‘an expert’ at Cigna to look at your medical claim and determine the fate of your care. A whopping 1.2 seconds. They do it… 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

Every few years, contract negotiations between payors and providers pull back the curtain on the innerworkings of the American healthcare system. The findings are gruesome. For reference, a recent article in Becker’s… Read More

You’re probably familiar with the phrase, “The road to hell is paved with good intentions.” The same can be said of prior authorizations. Decades ago, prior authorizations were designed with a reasonable… Read More

Between 2018 and 2021, Wilmington, North Carolina resident Stephanie Christy was covered under an individual health plan sponsored by Blue Cross Blue Shield of North Carolina (BCBSNC). Until she wasn’t…and was left… Read More

“Not medically necessary.” Says who…a doctor? No…an insurance company. And the insurance company here isn’t just any insurance company: we’re talking about UnitedHealthcare, the largest insurance company in the country. A company… 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

Let’s be real: Insulin is already expensive. A 2021 RAND report found that insulin costs approximately 10 times more for Americans than it does in other countries. So, we don’t need drug… Read More

Chronic conditions, such as diabetes, require management, care, and medications. When insurers create hurdles that directly or indirectly block access to care, those patients suffer. And apparently, that’s exactly what’s happening across… Read More

In case you’re not up to speed on the drama, managed care organization Centene is no stranger to legal settlements. We call it ‘managed care mischief’ — when a private company is… Read More

We’ve come a long way in modern medicine, especially when it comes to HIV care. In the mid-90s, life expectancy at age 20 for HIV-infected individuals was just 39 years old. Today,… Read More

To get a job done right, it’s often better to take care of it yourself. But that’s not necessarily the case for many states when it comes to health insurance coverage for… Read More

Maybe in 2023, the federal government will employ a fair way to settle billing disputes between hospitals and insurance companies. But with the Texas Medical Association (TMA) filing its third lawsuit this… Read More

What if there was an opportunity to make the biggest health insurance conglomerate in the United States even more powerful by equipping them with boatloads of sensitive health data? Imagine no more.… Read More

It’s the holiday season, a time for peace and goodwill, right? Well, not quite. Because it’s also the season for contract negotiations, err . . . disputes. And it looks like insurers… Read More

It’s another loss for UnitedHealthcare (United) in its ongoing legal battle with TeamHealth. The Tennessee-based emergency physician company has filed a total of ten lawsuits against UnitedHealth Group, but its most recent… Read More

It’s ironic, isn’t it? When hospitals, who are on the verge of closure following a brutal pandemic, decide that partnering with other providers is the only way to keep their doors open,… 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