Evidence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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