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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

In every way, Optum is getting bigger. And bigger, and bigger

We’ve said it before: One man’s pandemic is another man’s windfall. Especially when that “man” is UnitedHealth Group, which appears to be taking the profits it’s piled up during the COVID-19 pandemic… Read More

Unhappy birthday: An esoteric bit of insurance legalese throws new parents into six-figure debt

As we like to point out having health insurance doesn’t mean that you’re actually covered. While this plays out in any number of frustrating (and dare we say, dubious) ways every day, here’s… Read More

The slide toward regional health insurance monopolies picks up speed

With its 2020 “Competition in Health Insurance” study, the American Medical Association (AMA) set out to identify markets where the M&A of health insurance companies could cause competitive harm to consumers and… Read More

Miserly coverage for COVID-19 testing for children puts pediatricians in a no-win situation

In October, we shared a story about insurers actively blocking access to care and refusing to fully cover COVID-19 tests. Now, there are reports of insurers denying coverage for kids while passing the… Read More

Misled consumers fight back against “junk” health plans

“What you see is what you get” wasn’t the case for more than 200,000 consumers who thought they were scoring good deals on decent health insurance plans. Burned by a deceptive marketing… Read More

Legislators push to prevent a sudden loss of telehealth services after COVID-19

One of the few upsides of the COVID-19 pandemic has been the rapid rise of telehealth. In the past, federal legislation has limited Medicare coverage for telehealth, but thanks to policy changes… Read More

Oklahoma moves state Medicaid business to these 4 for-profit insurers

Oklahoma Governor Kevin Stitt announced the state is moving its Medicaid business to 4 for-profit healthcare companies: Blue Cross Blue Shield of Oklahoma, Humana Healthy Horizons, Oklahoma Complete Health (a subsidiary of… Read More

Top payor-provider trends to be on the lookout for in 2021

If we had to use one word to describe 2020, it would be “change,” and that’s particularly true in healthcare. Now that we’re several weeks into the new year (that was fast!),… Read More

Did Cigna take advantage of a surge in COVID-19 hospitalizations to deny claims?

New York resident Dinah Nissen was bitten on her right cheek by a dog in mid-May. After a clinician at a local urgent care urged her to see a plastic surgeon immediately,… Read More

Anthem reports decrease in profits for Q4, but that’s not the full story

Anthem recently reported $551 million in 2020 Q4 profits, a drop of 41% compared to the $943 million the insurer reported in Q4 of 2019. While at first glance, 41% may appear… 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.