Skip to Content

Who’s running the Medicare Advantage show?

Becker’s Hospital Review recently ran down the top for-profit insurers with the largest national share of Medicare Advantage members, based on a report by the Chartis Group, a healthcare management consulting firm.… Read More

United’s power play

As UnitedHealthcare continues to make bold moves—acquiring here, consolidating there—it’s managing to become the biggest health insurance entity in the known universe. As we’ve reported on several times, its health services subsidiary,… Read More

Megabucks for managed care

A massive arrangement has been reached between Ohio and six insurance companies hired to coordinate Medicaid managed insurance for more than 3 million low-income and/or disabled state citizens. It’s set to go… Read More

The 2021 financial prognosis for hospitals: Critical condition

If you look at the ledgers of the country’s largest health insurance companies, you could be forgiven for assuming that the COVID-19 pandemic has actually been a boon to the healthcare industry… Read More

Death by 1,000 prior authorizations

Providers hoping to treat their patients with radiation therapy may want to add some extra hours to their billing departments’ budgets. (And while they’re at it, they might consider prescribing them some… Read More

The battle of the blacklisted anesthesiologists

The New York Times recently devoted more than 1,000 words to the legal dispute between UnitedHealthcare and the private-equity-backed, physician-owned practice U.S. Anesthesia Partners (USAP). It’s an illuminating read—here are the highlights.… Read More

Humana’s operations expand—and so does its rap sheet

In the past few weeks, we’ve seen a glimpse of what Humana might look like as it grows in size and becomes a bigger employer. And, to be honest, we’re a little… Read More

Mississippi to Centene: I want my millions back too!

When the Mississippi Department of Medicaid contracted with Centene Corp. subsidiary Magnolia Health to manage care for the nearly half a million lower-income adults and children in its Medicaid system (MississippiCAN), state… Read More

United’s pending purchase of Change Healthcare goes under the DOJ’s microscope

You may have read our earlier coverage of UnitedHealthcare subsidiary Optum’s intended purchase of Change Healthcare, the enormous administrative network that processes claims and medication requests for physicians and pharmacies. Recently, the… Read More

“Information wants to be free”

So, here’s a clever way to bolster an insurance company’s annual profit report: Charge physicians to access claims payment data. Sound crazy? Well, that’s what UnitedHealthcare was doing, until recently, through its… Read More

Antitrustworthy: Michigan Blues customers see red

There seem to be a lot of antitrust issues with health insurers at the moment. Today’s tale involves a suit against Michigan Blues (the umbrella name for Blue Cross/Blue Shield and Blue… Read More

Humana finds a new name, runs familiar playbook

The health insurance behemoth Humana is about to embark on a rebranding initiative that will unite its primary care, pharmacy, and in-home care services under the name CenterWell. Its first two rebranded… Read More

It’s 2021: Do you know where your personal data is?

Earlier this year, UnitedHealth Group’s Optum subsidiary bought itself a present: the data analytics firm Change Healthcare, which is a massive administrative network that processes claims and pharmacy requests for physicians and… Read More

Ohio to Centene: I want my millions back!

Well, here we are again. Yet another group is calling in counsel—and calling out insurers—on their shady practices related to pharmacy benefit managers (PBMs). This time, it’s Ohio’s attorney general Dave Yost,… Read More

Telehealth has been a saving grace during the pandemic. Will insurers let it continue?

As a post-pandemic future takes shape, many of us are anxiously waiting to see how telehealth will be treated in upcoming contract hospital-insurer negotiations. Some analysts predict that hospitals are going to… Read More

Insurers edge physicians out of the medication process

This isn’t the first time the American Hospital Association (AHA) has flagged insurance company policies that take decisions regarding patient care away from the physicians they know and trust. Just recently, we… Read More

United vs. patients: The never-ending story

We feel for the UnitedHealthcare legal team. They must be worn out these days, what with so many lawsuits taking them to task for alleged misdeeds like fraud and illegally refusing to cover… Read More

Non-newsflash! Billions are wasted dealing with health insurance hassles

We’ve often wondered where the biggest healthcare sinkhole is when it comes to lost revenue due to administrative hassles. Until now, our guess was the drain on physicians’ and hospitals’ time spent… Read More

Who loses in a rigged game of high-deductible health plans? American workers, every time

We’ve all played three-card monte, right? Three cards face down; pick the queen and win the green. Why is this game so successful? Because the marks (the suckers who step up to… Read More

A denial for health insurers’ COVID-19 testing denials

We’ve recently shared a string of examples, from insurers dodging reimbursement for kids’ COVID-19 tests to insurance giant Cigna being sued into covering tests. Now the issue has reached the point where the… Read More

Super-sized Cigna

The telehealth company MDLive, one of the biggest telehealth platforms in the country, will be acquired by Evernorth, Cigna’s recently rebranded health services unit. The deal is expected to close in Q2… Read More

Where do health insurance companies’ billions in profits go? A lot of it rises to the top

The article was based on consulting firm BDO’s recently released Health Insurance Executive Insights Report, which covers compensation for executives and senior managers at health insurance companies, including UnitedHealth Group. According to… Read More

Why Medicaid contracts worth $2.1 billion shouldn’t go to private insurers

As we recently noted, the Oklahoma Health Care Authority (OHCA) decided to shift management of its Medicaid business to four for-profit health insurance companies, including UnitedHealthcare, in a deal estimated to be… Read More

Beware of cherry-picked data from RAND

The RAND Corporation released an Impact of Policy Options for Reducing Hospital Prices Paid by Private Health Plans “study” that claims to have found upwards of $62 billion in potential healthcare savings—if… Read More

Un-covered on Twitter

Subscribe to Un-covered Essentials

Insurer policies limit coverage and disrupt patient care, while producing record profits for corporate shareholders. Stay informed with the Un-covered newsletter.