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One PBM is taking the “special” out of “specialty care”

When it comes to specialty conditions such as HIV/AIDS, multiple sclerosis, rheumatoid arthritis, anemia, and even cancer, the “special” label that describes the condition, medication and care isn’t a meaningless label. These… Read More

We’ve got eyes on payors during negotiation season

Ah, fall. The temps are dropping, Thanksgiving is just around the corner, the Christmas holiday will be here before we know it, and… insurers are cutting hospitals out of their networks. Wait,… Read More

The big get bigger, but at whose expense?

It seems like the rollercoaster that never drops. As if you couldn’t guess, yes, we’re talking third-quarter earnings for two of the biggest insurers. Anthem and UnitedHealthcare saw a dramatic increase in… Read More

Did insurers get a “thumb on the scale” in the No Surprises Act?

Surprise bills, be gone! Spooky season may be over, but the holiday season is here, and we still hope there’s some magic left in the air to rid patients of surprise bills… Read More

Optum strikes its biggest hospital deal yet – but is it for the greater good?

We’ve said it before: Optum is getting bigger. A subsidiary of UnitedHealthcare, Optum has inked its largest health system deal yet, Healthcare Dive reports. After another successful quarter (if you’re a shareholder,… Read More

Do health insurance monopolies cause poor health?

Big Appliance. Big Oil. Big Dairy. Big Pharma. Annnnnd Big Health Insurer. Not that we needed more evidence to prove the big business of health insurance, but a recent article in Modern… Read More

Are anesthesiologists’ UnitedHealthcare contracts going under?

Anesthesiologists are in a painful situation, which is unfortunate considering their job is to help manage pain. In a recent article in Modern Healthcare, the American Society of Anesthesiologists (ASA) claims that… Read More

Centene and the Managed Care Mischief

Our friends Centene Corporation are back with the next installment of our favorite series: Managed Care Mischief. According to an article in Healthcare Dive, Centene’s settled another set of allegations that it… Read More

You get a bill, you pay it. Right? Not these two top health insurers…

A pair of insurers have yet to pay their bills, and we aren’t talking chump change. Provider representatives say the insurers are billions of dollars behind on payments owed to hospitals and… Read More

Breaking news for the DHHS…but not for us

Finally, at (very) long last, the Department of Health and Human Services (DHHS) is putting the many pieces of Medicare fraud together. An exclusive report in the Wall Street Journal explains that… Read More

Spotted: More growth for Humana?

Word on the street (StreetInsider, to be specific) is that Humana has its eye on a shiny new purchase: Medicaid managed-care organization (MCO), Centene. A recent Fierce Healthcare article gives us the… Read More

Blue Cross Blue Shield, will you ever learn?

Remember back in May, when Blue Cross Blue Shield (BCBS) settled for a cool $2.67 billion in a highly publicized antitrust case? We sure do. Here’s a refresher: The BCBS Association was… Read More

More ghost networks, just in time for Halloween

Another ghost network story is giving us chills. A new whistleblower case reported in Modern Healthcare, alleges Aetna illegally secured contracts with Pennsylvania’s Medicaid program, HealthChoices, by misrepresenting the number of pediatricians… Read More

A private health plan mismanaging government funds? Color us shocked.

The Centers for Medicare & Medicaid Services (CMS) suspended enrollment in not one, but three Medicare Advantage plans offered by UnitedHealthcare. What happened? Well, the Social Security Act requires that health insurance plans have… Read More

Is this mic on? We’ve been looking for some clarity on record-breaking profits for insurers

We interrupt our regular programming to take you back to Connecticut, where insurance scrutiny remains high. Which, if we’re being honest, is our regular programming. Just last week, we covered the Connecticut… Read More

Is United penny-pinching pediatricians?!

UnitedHealthcare is known for denying coverage. Old story, we know. But now, they’ve targeted pediatricians. Seems a little aggressive, right? The American Academy of Pediatrics (AAP) seems to agree, and they aren’t… Read More

Here’s what we know about the latest reconciliation bill drama

Change is a-coming, as it normally does during a new legislative year. This year, Congress is mid-debate on Biden’s bipartisan infrastructure bill and Democrats’ $3.5 trillion reconciliation bill, which includes Medicare reform.… Read More

Surprise! But not the good kind

You got your COVID-19 vaccine. You get your COVID-19 tests as necessary. Due diligence has been served, right? Well, don’t look behind you—here come the COVID-19 testing bills (and collection agencies). Per… Read More

Anthem forced to foot the bill for eating disorder coverage

Eating disorders are common—the mental health disorders affect nearly 30 million Americans. This is no small number, nor is the price tag associated with its care. An article in Becker’s Hospital Review… Read More

We have a hospital bed pile-up… that could easily be prevented

In a time when the Delta variant is raging and post-acute patient care is needed most, this is not the time for setbacks or bureaucracy. Leave it to insurers, though: Medicare Advantage… Read More

(Some) states push back on rate increases—finally!

It’s that time of year. No, not just for pumpkin spice lattes, but for health insurers to petition state Departments of Insurance for the next year’s rate increases. Everybody, brace yourselves. Each… Read More

D.C. Circuit overruling means the game is afoot!

A new court case has us predicting more False Claims Act suits against private payors operating Medicare Advantage plans. Let’s hope so, but first, let’s break it down. First: Medicare Advantage. Private… Read More

Who is responsible for preparing states for healthcare “storms”?

Storm preparation is a major priority for many cities across the nation, and rightly so. But where’s the preparation for healthcare “storms,” like COVID-19? Mississippi has what’s believed to be the weakest… Read More

Our take on Michigan insurers: “Another COVID-19 surge? Sounds like a ‘you’ problem…”

We sure hope you’re vaccinated, Michiganders! (And hope you don’t catch a breakthrough infection, despite your best efforts.) Your state’s two largest carriers are sunsetting COVID-19 cost waivers. You heard that right.… 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.