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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.
Evidence
All the proof that payors are putting wealth over health.
UnitedHealthcare’s tactics aren’t so bright in the Sunshine State
It’s time to roll out the insurer red carpet – straight to court! According to an article in the Orlando Sentinel, UnitedHealthcare (United) recently shelled out more than $4.7 million to UF… Read More
The Three Worst Insurance Trends of 2021
Insurance companies sure found plenty of creative ways to make money in 2021. Some we expected, some were new, and many made it harder for patients to access the healthcare services they… Read More
Centene and the settlement saga
“Centene” and “settlement” are two words that have come up so many times this year, we can’t even count. And it’s not stopping yet. Another million-dollar settlement is on the table for… Read More
More insurers caught underpaying COVID-19 claims – here’s looking at you, Anthem
A few weeks ago, we shared that after providers – namely, pediatricians – complained that the insurer was paying them substantially below market rate to administer COVID-19 vaccines, UnitedHealthcare agreed to reprocess its COVID-19… Read More
Seeing beyond the peak of UnitedHealthcare’s revenues
No mountain is too high when it comes to revenue expectations for UnitedHealthcare. 2020 was good, 2021 was better, and in 2022, we can’t even see the peak yet. Per a recent… Read More
Humana pats itself on the back in new report
“Home health” has been a buzzword for years, even more so during the pandemic. It’s also been an investment focus for many health insurers – most notably, Humana. But two recent stories… Read More
The (first) jury is in, and UnitedHealthcare takes the hit
The jury has deliberated; the gavel has landed, and an insurance company is forced to face the repercussions of its actions. According to a recent article in Modern Healthcare, Tennessee-based emergency physician company… Read More
Insurers start to feel the contract-cutting heat
In our opinion, hospitals usually bear more than their fair share of blame when insurers make cuts to their health plan networks. To be fair, not every hospital is always in the… Read More
Are pharmacy benefit managers a prudent service – or a profit scheme?
Pharmacy business managers (PBMs) control the cost of prescriptions for patients. This might sound like a good thing – theoretically, by monitoring prescription costs, PBMs are supposed to increase access to necessary… Read More
Anthem and BlueCross BlueShield: A “whoopsies,” of sorts
In general, making a “whoopsie” is not terribly sinister. We can forgive the occasional mess-up. But for big insurers, when there’s a processing error, it’s a big deal. Case in point: Remember… Read More
UnitedHealthcare reconsiders pandemic underpayments
When it comes to underpaying for COVID-19 care, you almost can’t blame UnitedHealthcare for trying. Well, actually, we can. After providers, largely pediatricians, complained that United was paying them substantially below market… Read More
A royal flush of managed care mischief
Ohio, Mississippi, Arkansas, Illinois – and now, Iowa. By this point, you could probably tell the tale of misused state dollars as well as we can…but here we go again. In 2016,… Read More
More Medicaid trouble in Ohio
Today, we’re talking about “clawbacks.” And yes, they are as scary and painful as they sound. Before we explain what’s going down in the Buckeye State, here’s a refresher on PBMs. These… Read More
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