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Good news: North Carolina expanded Medicaid. Bad news: It’s not a silver bullet.

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

‘A system built to deny claims’: Insurer denials frustrate patients and providers

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

Bad BCBSNC bill gets more time to become worse

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

Hospitals attempt to stay afloat amidst nasty contract negotiations

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

Prior authorizations are a bureaucratic bad idea

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

1, 2, 3 . . . it’s a big jump to 273

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

News flash: your health insurer thinks it knows more than your doctor

“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

The one where Blue Cross Blue Shield Association calls the kettle black

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

Why is insulin so expensive? California alleges manufacturers and pharmacy benefit managers are gaming the system

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

Wait…high-deductible plans prove dangerous for patients? No way!

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

Despite millions in settlements, Centene’s doing just fine

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

What good are medical advances if insurance won’t pay for them?

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

TennCare’s convenient self-congratulations

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

No surprises here: Another suit alleges insurers have the upper hand in claims disputes

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

A deep dive into the risks of the UnitedHealth and Change Healthcare merger

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

Sugar and spice, not everything’s nice…

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 legal loss for UnitedHealthcare

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

Insurance competition keeps weakening

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

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

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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.