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Evidence
All the proof that payors are putting wealth over health.
‘Twas the Fight Before Christmas
It’s the holiday season—the time for good cheer, giving back, and counting our blessings. But while everyone else is focused on generosity, Anthem Blue Cross Blue Shield seems fixated on just the… Read More
Anthem’s Anesthesia Fiasco: A Window Into Years of Harmful Practices
Anthem just got caught trying to play doctor in the boardroom—again. Recently, the insurer proposed a policy that would let them decide how long patients “really” need anesthesia, essentially second-guessing trained physicians… Read More
Health Insurer or Data Hoarder?
Earlier, we shed light on how Anthem is running the same harmful playbook across the country—prioritizing profits over patients. The ongoing dispute between Anthem and Memorial Sloan Kettering Cancer Center (MSK) as… Read More
Anthem’s Invisible Hand?
Cut/paste style messages may suggest a coordinated strategy against health systems Across the country, healthcare providers continue to feel the crushing weight of inflation, increased labor and supply expenses, and other cost… Read More
Another payor-provider breakup
What are hospital systems supposed to do if insurers refuse to play fair? As of February 1, Blue Cross Blue Shield of Arizona (BCBSAZ) is out of network with San Francisco-based Dignity… Read More
Premium dollars or lives? For BCBSNC, we’re not sure there’s a difference.
Blue Cross Blue Shield of North Carolina has been booted . . . from the state health plan, that is. For decades, hundreds of thousands of North Carolinians have been getting their… Read More
No surprises here: Insurers failing to uphold their end of the No Surprises Act
It seems simple: Established in 2022, the No Surprises Act seeks to limit the amount of out-of-pocket expenses that patients might get stuck with when their insurance company is out of network… Read More
Hey North Carolina, be wary of BCBSNC’s growth plan.
In our healthcare ecosystem filled with disruptors, some health insurance companies are trying to take a (very big) bite. At least, that’s what Blue Cross and Blue Shield of North Carolina (BCBSNC)… Read More
Some insurance companies employ doctors with medical malpractice suits to review claims.
Where do doctors with malpractice claims go? In some cases, to insurance companies. To be sure, not all doctors working for insurance companies have faced malpractice suits, nor do all who have… Read More
Yet another health insurance company is using AI to deny medical claims.
It’s 2024, and AI is in the air — it’s everywhere. Especially in healthcare. Whether it’s imaging software that can help doctors quickly identify and diagnose diseases; predictive insights that help optimize… Read More
An insurance merger is back from the dead—but who benefits?
It’s a new year, and one with big opportunities for the powers that be at Elevance Health. As of mid-December, the health insurance giant’s $2.5 billion acquisition of Blue Cross and Blue… Read More
We don’t care, say insurers: Payors bypass state laws and deny care.
North Carolina. Oklahoma. Michigan. Maine. Arizona. California. These are just some of the states where health insurance companies are denying patients their due care — and, as a result, lawmakers are speaking… Read More
It’s the battle of the PBMs.
It’s the battle of the pharmacy benefit managers (PBMs). If you need a refresher, PBMs are third-party companies that health insurance companies use to handle prescription drug benefits for their health plans.… Read More
Another algorithm to say ‘no’ to your care
Nice try, UnitedHealthcare . . . The nation’s largest health insurer has recently found itself in hot water over an algorithm it uses to deny rehabilitation care for Medicare Advantage beneficiaries. According… Read More
Prior authorization reform? We’ll believe it when we see it.
You know when someone says they’re sorry only because they got caught? That’s what it feels like with health insurers and prior authorization reform. Even though some of the largest health insurance… Read More
The data keeps rolling in — claim denials continue to impact patient care
Health insurance companies continue to cook up creative strategies to shortchange health systems through underpayments, non-payments, and — it’s the big one! — claim denials. These strategies reduce what gets reimbursed to… Read More
Insurance companies continue to squeeze dollars out of Medicare Advantage
Let’s say you run a big, unwieldy, expensive government program. You want to trim costs, but your program provides services in all 50 states for more than 65 million Americans, and you… Read More
A conflict of many interests: Cloverfields Capital Group and its ties to UnitedHealth Group
When it comes to avoiding insider trading, guess we’ll just have to take UnitedHealth Group’s word for it. The sticky situation is this: Stephen Hemsley, the former CEO of UnitedHealth Group and… Read More
Deflecting blame is an insurer’s specialty
It’s that time of year again . . . insurers across the country are starting to release their 2024 rates. It’s also that time of year again when insurers deflect their rate… Read More
Expect to be denied: Claim denials are on the rise
If there’s one thing you can count on in the American healthcare system, it’s claim denials. At least, that’s what the research tells us. According to a recent Kaiser Family Foundation (KFF)… Read More
Doctors are slapped with fees when opting for electronic funds
Insurers will do just about anything to make a buck. Including taking money owed to physician practices and hospitals. According to an article from ProPublica, insurers take cuts from physician reimbursements if… Read More
Doctors and patients are getting loud online. Here’s why.
North Carolina resident Sally Nix has had enough with prior authorizations. Afflicted with a combination of autoimmune diseases since 2011, brain and spinal surgeries failed to relieve Nix’s chronic pain and fatigue.… Read More
Another survey reveals the dark underbelly of commercial health insurers
Back in July, the American Hospital Association (AHA) released findings from three surveys conducted by Morning Consult on the practices of commercial health insurers. The findings weren’t great. Patients, nurses, and physicians… Read More
Prior authorizations are (still) a bad idea.
We’ve said it before, and we’ll say it again: Prior authorizations are a bureaucratic bad idea. At least, they are for physicians and patients. But while prior authorizations can be a minor… Read More