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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

More than 500 rural hospitals at risk for closure before pandemic hit

Stories of rural hospitals being forced to shutter their doors because of financial strain are unfortunately becoming more and more commonplace, but this latest data from the Center for Healthcare Quality and… Read More

The AHA flags new UnitedHealthcare policies for federal scrutiny

Two new seemingly unrelated policies being rolled out by UnitedHealthcare—one on labs and the other on specialty drug distribution—have been flagged by the American Hospital Association (AHA) as problematic for the same… Read More

Update on United’s acquisition of Change Healthcare: Shareholders and providers expressing concern

In early January, we shared our point of view on UnitedHealthcare’s planned acquisition of the data company, Change Healthcare. To no one’s surprise (at least not ours), there is some controversy surrounding… Read More

New year, but same old story… UnitedHealth Group rakes in billions

It is no secret that 2020 was a good—no, make that great—year for UnitedHealth Group. As we covered previously, even a “bad” quarter for this company was still leaps and bounds ahead… Read More

Optum sets its sights on Massachusetts’ largest independent physician group

When we look at the trend toward vertical integration in the insurance industry (i.e., insurance giants gobbling up pharmacy benefits managers, data and analytics companies, specialty pharmacies, digital patient monitoring platforms, provider… Read More

Blues plan switches to a United-owned PBM

Blue Cross Blue Shield of Michigan and Blue Care Network recently announced they are switching from Express Scripts (owned by Cigna) to OptumRx (owned by UnitedHealth Group) with the intention of reducing… Read More

CMS approves new rule aimed at easing the burdens around prior authorizations

Despite strong pushback from health insurers, The Centers for Medicare & Medicaid Services (CMS) went ahead and finalized a rule, first proposed in late 2020, that is aimed at regulating the industry.… Read More

Massachusetts governor acts to protect virtual care coverage

In October of 2020, we covered a story about health insurers rolling back coverage for telehealth services, right as demand was skyrocketing due to COVID-19. During the pandemic, virtual visits have been… Read More

Aetna just cut Walgreens from its Medicaid plan in Illinois

Ever since the CVS/Aetna deal closed in late 2018, we’ve been tracking how the merger of a major insurer with a pharmacy and healthcare services giant will impact the choices individuals with… Read More

Centene expands into behavioral health with a $2.2B acquisition, just weeks after dipping further into pharma

On January 4, 2021, Centene announced a definitive agreement to acquire Magellan Health, an insurer with a vast behavioral health network, for $2.2 billion. Centene claims that in light of the pandemic,… Read More

UnitedHealthcare just cut thousands of emergency room docs from their 2021 network

We rang in 2021 with yet another big move by UnitedHealthcare: its decision to cut Envision Healthcare from its network after the two companies were unable to come to an agreement regarding… Read More

CMS is pushing payors to improve prior authorizations processes

It looks like prior authorizations—or more specifically, the myriad challenges providers face around prior authorizations—are becoming an Un-covered theme. If you’ve been following our feed, you’ll recall that we recently shared our… Read More

United buys itself a $13 billion holiday present

Looks like UnitedHealthcare might have been saving up all those profits to buy itself an extravagant New Year’s gift. In early January, United’s subsidiary Optum announced that it will purchase the technology… Read More

Hospital claim denials are on the rise, especially those related to prior authorization issues

According to RevCycle Intelligence, a new survey of 200 hospitals conducted by the American Hospital Association (AHA)—and supplemented by interviews and group discussions with several hundred additional hospital and health system executives—found… Read More

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