Payer Issues

It’s no secret that the HR function has become more complex in recent years. Thanks to policy changes in State Paid Sick Leave, the Affordable […]

It’s no secret that the HR function has become more complex in recent years. Thanks to policy changes in State Paid Sick Leave, the Affordable […]

From the Blue Cross Blue Shield Association finding its top-level information security officer to Colorado Access making history with its new president and CEO — […]

A record-setting 14.5 million Americans signed up for health coverage since open enrollment began Nov. 1. 

A record-setting 14.5 million Americans signed up for health coverage since open enrollment began Nov. 1. 

Cigna discussed a potential acquisition of Centene in the final months of 2021, but nothing has come of the preliminary conversations, according to a Jan. […]

The rapidly changing healthcare landscape, along with unrelenting pressure to control costs, challenges payers to find better ways to manage the complex cost allocation processes.

From a 2021 earnings report with mixed takeaways to leadership earning one of the National Collegiate Athletic Association’s highest honors, here are five recent headlines […]

Two North Carolina payers — Aetna Better Health Care and My Health by Health Providers of Morrisville — are stepping away from the table after […]

President Joe Biden is exploring requiring coverage of at-home COVID-19 tests for Medicare beneficiaries in addition to private commercial members, according to a Jan. 26 […]

Anthem reported $137 billion in year-end revenue for 2021, anchored by government market and pharmacy growth as commercial development seems to stall. 

Electronic claim payment trends all point to one dynamic: faster turnaround. Simply put, businesses and consumers now expect near-immediate access to funds when they have […]

Excellus BlueCross BlueShield has agreed to a settlement for a class-action lawsuit over a 2015 data breach, according to fingerlakes1.com. 

The Blue Cross Blue Shield Association announced Chris Lugo as the organization’s vice president and chief information security officer. 

A Labor Department report found faults both in provider and payer mental health parity, and is now moving forward to further enforce parity and “correct […]

Nineteen senators co-signed a letter to HHS and CMS urging the agencies to cover at-home COVID-19 tests for Medicare beneficiaries. 

Although the price transparency elements of the No Surprises Act do shake up the payer-provider dynamic, the true controversy surrounding the act involves out-of-network rate […]

Anthem Blue Cross Blue Shield named Robert Bunch president Jan. 20, but the move comes as the payer potentially faces a new opponent in its […]

The coverage gaps created by the Biden administration’s at-home COVID-19 test coverage guidelines doesn’t solve barriers for a population that faces already-increased risks: Medicare beneficiaries, […]

The widespread adoption of telehealth is what UnitedHealth Group CMO Mary-Margaret Wilson, MD, calls “one of the most dramatic changes” in healthcare, but the next […]

HHS’ Office of the National Coordinator for Health Information Technology is looking for public comments on prior authorization to help guide standards, implementation and certification. 

From a pair of Blue Cross Blue Shield presidents slated to retire to GuideWell naming its first chief health equity officer, here are nine recent […]

GS Labs is responding to a July 2021 lawsuit from Blue Cross and Blue Shield of Kansas City with a counterclaim that alleges the payer […]

Virtual care isn’t just seeing an increase in patient volume amid the COVID-19 pandemic, but also an increase in patient savings, according to a Cigna […]

UnitedHealth Group may be slated to give more attention to home-based care, company executives said during a Jan. 19 earnings call. 

Six of the nation’s 13 largest payers currently offer direct coverage for at-home COVID-19 tests, according to a Jan. 20 Kaiser Family Foundation study. 

The prices commercial insurers pay to providers continues to grow higher than the price set by Medicare’s fee for service program, according to a report […]

More than 120 organizations — including payers, businesses and advocacy groups — have signed on to a coalition that opposes proposals that would enact and […]

Gail Boudreaux, Anthem CEO and president, was awarded the National Collegiate Athletic Association’s highest individual honor: the Theodore Roosevelt Award. 

Humana subsidiary CenterWell Senior Primary Care, the largest senior-oriented primary care provider in the nation, is expanding its reach to 12 states. 

From growing to become the largest Blue Cross Blue Shield affiliate to its varied history of acquisitions, here are 20 things to know about Anthem. 

Following CMS’s preliminary decision to limit the coverage of Biogen’s Alzehimer’s disease treatment Aduhelm, advocates are calling on the agency to broaden its coverage or […]

Two groups representing payers — America’s Health Insurance Plans and the Blue Cross Blue Shield Association — filed amicus briefs supporting HHS against a lawsuit […]

Sartell, Minn.-based Center for Pain Management is challenging Blue Cross and Blue Shield of Minnesota’s decision to terminate its network contract, according to the St. […]

More than 30 lawmakers penned a letter to CMS Administrator Chiquita Brooks-LaSure Jan. 18 asking her to reevaluate the proposed 14.5 percent increase to Medicare […]

UnitedHealth Group posted its 2021 year-end earnings report Jan. 19, revealing strong operational earnings that slightly outpaced expectations. 

UnitedHealth Group will release its fourth quarter earnings report on Jan. 19, and the company is positioned to maintain the momentum it saw in the […]

Oscar Health announced that a vendor printing issue may have led to the mishandling of member information, according to a Jan. 14 news release. 

From trailblazing both stakeholder commitment and remote work to closing the books on a pair of lawsuits, here are seven recent stories on UnitedHealth Group, […]

Ethan Berke, MD, UnitedHealth Group chief public health officer, said any COVID-19 strategy should follow three steps: take a deep breath, step back and follow […]

Andrew Agwunobi, MD, will lead Humana’s home solutions business as its president, the payer announced Jan. 14. 

From Optum investing in genomic sequencing to UnitedHealthcare broadening its vision benefits with laptop discounts, here are five recent payer partnerships and expansions. 

ACA open enrollment numbers are continuing to set records, but as the Jan. 15 signup deadline nears, the influx of workers leaving their jobs are […]

Under a time crunch, payers are bracing for a messy rollout of a new federal rule requiring insurers to cover at-home COVID-19 tests, The New […]

From its roots as one of the country’s oldest insurers to its leading efforts in the pharmacy benefit management space, here are 20 things to […]

Ten providers — including U.S. Anesthesia Partners, St. Luke’s University Health network and Children’s Wisconsin — recently posted job listings seeking leaders to help payer […]

From Anthem’s effort to overturn a court order affecting 400,000 patients to Blue Cross Blue Shield of Tennessee being sued over firing an unvaccinated employee, […]

California is the latest state to sue The Aliera Companies and its owners, the Moses family, alleging they denied members’ medical claims through cost-sharing ministries […]

In 37 states, 10 percent or more of workers’ median income goes toward health insurance premiums and deductibles, a Jan. 12 analysis by the Commonwealth […]

Six payers were recognized by nonprofit JUST Capital for their commitment to stakeholder responsibility, with three ranking among the top 100 U.S. companies.

Leslie Norwalk, a former Magellan Health board member, is joining Centene’s board of directors, the payer announced Jan. 11.

The U.S. District Court for the Eastern District of New York approved a $10 million final settlement for a class-action lawsuit targeting UnitedHealthcare and its […]

CMS intends for Medicare to cover Aduhelm, Biogen’s Alzheimer’s disease treatment, for patients taking part in clinical trials, the agency announced Jan. 11. 

CMS intends for Medicare to cover Aduhelm, Biogen’s Alzheimer’s disease treatment, for patients taking part in clinical trials, the agency announced Jan. 11. 

Anthem filed a pair of motions Jan. 7 that aim to end a temporary court order requiring it keep Atlanta-based Northside Hospital System in its […]

Anthem filed a pair of motions Jan. 7 that aim to end a temporary court order requiring it keep Atlanta-based Northside Hospital System in its […]

The Health Resources and Services Administration is expanding ACA preventive care and screening coverage for women and children, HHS announced Jan. 11.

North Carolina awarded CVS Caremark, CVS Health’s pharmacy benefit manager, a $3.4 billion contract to serve the state’s 727,000 public employees. 

Payer representatives are both praising President Joe Biden’s sweeping new at-home COVID-19 test coverage policy and raising concerns over its implementation and impacts. 

Private insurers must cover the cost of up to eight at-home COVID-19 tests per month effective Jan. 15, according to an HHS news release.

HHS announced 13.8 million people are enrolled in an ACA plan, expanding on an enrollment record set in December, according to a Jan. 10 news […]

HHS Secretary Xavier Becerra is ordering CMS to review its 2022 Medicare Part B premiums following the announcement that Biogen would be slashing the price […]

Payers maintain one of the few remaining ways of holding accountable the 15 percent of U.S. adults unvaccinated against COVID-19: leveraging insurance surcharges and discounts, […]

New Hampshire’s Justice Department announced a $21 million settlement with Centene and two of its subsidiaries — Granite State Health Plan and NH Healthy Families […]

A California court ruled against United Behavioral Health, a UnitedHealth Group subsidiary, ending a multiyear class-action lawsuit and requiring the provider pay out over $20 […]

While conversations around partisanship, funding and education surround President Joe Biden’s Build Back Better Act, spectators are largely ignoring how close the bill brings the […]

An HHS Office of Inspector General audit of seven Healthfirst Health Plan high-risk groups found several diagnosis codes submitted for use in CMS’ risk adjustment […]

CMS is proposing a new rule that aims to cut prescription drug costs, increase contract vetting and improve health equity, according to a Jan. 6 […]

Centene, Excellus Blue Cross Blue Shield and Kaiser Permanente all named new executives since Jan. 1. 

California’s state Assembly is considering two bills to establish and fund universal healthcare in the state, according to a Jan. 6 Newsweek report. 

Humana is nearly halving its 2022 estimates for Medicare Advantage enrollment to reflect “higher than anticipated” terminations during the last enrollment period, according to a […]

Payers should brace for an increase in joint pain, cardiomyopathy and diabetes-related claims throughout 2022, according to a report from health insights company Prealize. 

Centene has appointed Jim Murray as its chief transformation officer to lead both the payer’s new Value Creation Office and its advanced behavioral health division.

Humana is indefinitely postponing a return to in-person work for employees around the country as the number of COVID-19 cases continues to rise, a spokesperson […]

Two Anthem employees filed a class-action lawsuit Jan. 3 alleging that the insurer refused to pay enrollment employees overtime compensation despite being required to work […]

Four U.S. health insurers were listed among the top 10 insurance companies in the world by net premiums written, according to a Jan. 4 AM […]

UnitedHealthcare will not enact a controversial policy regarding emergency care coverage in 2022, according to a Dec. 30 letter CEO Brian Thompson wrote to the […]

Louisiana’s Medicaid expansion in July 2016 is associated with reduced travel for all medical service lines and especially helped Black Medicaid enrollees in nonmetropolitan areas, […]

From a former CEO moving to lead the largest hedge fund in the world to endometriosis surgeons claiming the payer is unjustly denying claims, here […]

Days after securing final regulatory approval, Centene completed its $2.2 billion acquisition of Phoenix-based behavioral health provider Magellan Health, the company announced Jan. 4. 

UnitedHealthcare CEO Brian Thompson confirmed that the payer will not be making changes to its criteria for emergency care coverage, according to the American Hospital […]

Mark Bertolini, former CEO of Aetna, was named co-CEO of Bridgewater Associates, the largest hedge fund in the world, according to a Jan. 3 news […]

Biogen slashed the price of its controversial Alzheimer’s drug Aduhelm after a problematic  rollout, but the move has still done little to encourage Medicare to […]

Nearly 400,000 patients affected by a contract dispute between Anthem and Atlanta-based Northside Hospital System will maintain in-network rates for another month after a judge […]

More than 27 million Americans are enrolled in Medicare Advantage plans, and insurers are signaling it may be a fruitful market worth more of their […]

CMS approved California’s Medicaid proposal — called California Advancing and Innovating Medi-Cal — which aims to make the state’s Medicaid program more equitable.

Cigna is strengthening its leadership, partnerships and networks as it rounds out 2021.

From its 2018 acquisition by CVS Health to its future in virtual and integrated care, here are 20 things to know about Aetna. 

Ten providers — including University of Chicago Medicine, Texas Children’s Hospital and Denver Health — recently posted job listings seeking leaders to help payer contracting […]

From sprawling contract renewals to relationships built on member value, here are seven recent payer expansions and partnerships. 

A proposed rule from HHS is aiming to make it easier for consumers to compare ACA marketplace health insurance plans and promote health equity. 

UnitedHealth Group and Aetna were both named in lawsuits for allegedly denying claims and underpaying surgeons who provided advanced endometriosis treatment. 

Behind Centene’s leadership overhaul is alleged pressure from the payer’s $900 million financial backer, Politan Capital Management, which is led by activist investor Quentin Koffey. 

With a month remaining until enrollment closes, HHS announced that a record-setting 13.6 million Americans will receive health insurance coverage in 2022 through the ACA […]

From providing health coverage for 48.4 million people as the largest payer in the country to reaching 127 million individuals through health services and provider […]

Arkansas Gov. Asa Hutchinson received federal approval to begin its Medicaid expansion redesign, dubbed ARHOME.

Here are 20 things to know about Centene, the largest Medicaid managed care organization in the country.

A New York judge ruled on the future of New York City’s controversial retiree Medicare contract after its rollout was put in limbo. At the […]

A New York judge ruled on the future of New York City’s controversial retiree Medicare contract after its rollout was put in limbo. At the […]

Health Care Service Corporation’s Texas arm paid the most out of any insurer in medical loss ratio rebates for the 2020 reporting year at nearly […]

Payers have provided about 9.8 million members with nearly $2 billion in premium rebates for the 2020 coverage year, according to CMS.