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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.
Care and Access
Payors create administrative burdens and restrictive policies that prevent patients from accessing care and block providers from delivering it.
American Hospital Association begs feds to enforce the law
According to a recent article in Fierce Healthcare, in late May the American Hospital Association (AHA) published a letter to the Department of Justice (DOJ) pleading for an investigation “into commercial payers… Read More
Is anyone getting the mental health coverage they pay for?
How much more evidence do we need? You don’t have to go far to find examples of health insurance companies denying coverage or making it exceedingly difficult to access in-network care. Maybe… Read More
Medicaid expansion: just a bandage for wounds inflicted by NC health insurers
We’ve been sounding the alarm for quite some time now: Rural hospitals struggled before COVID-19. They barely held on during the pandemic. And if private health plans continue to slash reimbursements, rural… Read More
The truth behind hospital costs: rural areas bear the brunt
Health insurers must face the facts — and admit their role in increased rural hospital closures.
A ‘game of chicken’ in North Carolina? Doesn’t look like fun to us
A recent article in WUNC North Carolina Public Radio calls a contract dispute between WakeMed and UnitedHealthcare ‘a game of chicken.’ But is this a fair fight?
The latest victim of health insurance roadblocks? HIV prevention.
A recent Axios article highlights the hoops patients have to jump through to access PrEP, the essential HIV prevention medication, in spite of federal rules
Patients over profit: How rural maternity units are barely hanging on
Losing a maternity unit is not just bad for the health of OB-GYN patients, but for the health of the hospital. Can rural hospitals safely deliver babies when reimbursements keep dropping?
Certain telehealth coverage is ending for NC Medicaid patients – are private insurance plans next?
The increased use of telehealth is one of the few good things to come from the pandemic. Telehealth has enabled thousands of patients across the country to access their doctor from the… Read More
A slap on the wrist for Blue Cross Blue Shield of Georgia, Inc.
Imagine the scandal of your local hospital getting charged $5 million for failing to treat patients in emergencies or your supermarket being fined $5 million for failing to report a salmonella outbreak… Read More
Partnerships mean survival for small hospitals
There’s a narrative going around – one that’s repeated mostly by big health insurers and the politicians in their pockets. The story is small hospitals are being swallowed up by big hospitals. And… Read More
Why does UnitedHealthcare seem to have such trouble covering mental healthcare?
On the heels of a traumatic, COVID-ridden three years, overdoses have spiked, and substance abuse disorders are rising. And despite being federally required to cover mental healthcare at the same level as… Read More
Another coverage “error” for BlueCross BlueShield
Health insurance is a tricky business. In most lines of work, you can’t just say one thing and then do another. But as it turns out, if you’re a big enough insurance… Read More
Insurers claim hospitals are in it for the money – is it projection, or deflection?
Health insurance companies would like you to believe that hospitals – despite being filled with folks dedicated to saving lives – are not on the side of patients. They’d like you to believe that… Read More
North Carolina hospitals save lives—but who’s going to save theirs?
North Carolina is known for many things: gorgeous mountains, delicious barbecue, and college basketball. But in December, North Carolina was recognized for something not-as-exciting: The state came in third on the list… Read More
Fiery words from Northside Hospital: Anthem decision defies ‘logic and sensitivity’
Ooh, those are fightin’ words! Northside Hospital held nothing back in a recent statement on its efforts to stay in-network with Anthem Blue Cross Blue Shield. The hospital has been battling with… Read More
UnitedHealthcare officially walks back controversial ER policy
What’s that saying? When you find yourself in a hole, quit digging? Looks like UnitedHealthcare (United) finally caught wise that attempting to implement stricter criteria for emergency services was ditch-digging at its finest. In… Read More
Our Un-covered hero of the month: Insurance fighter Jackie Fox
If there was a good egg in the Un-covered world, it would be law professor Jackie Fox, who takes on patients’ insurance battles for fun – and wins. Kaiser Health News’ podcast… Read More
More insurers caught underpaying COVID-19 claims – here’s looking at you, Anthem
A few weeks ago, we shared that after providers – namely, pediatricians – complained that the insurer was paying them substantially below market rate to administer COVID-19 vaccines, UnitedHealthcare agreed to reprocess its COVID-19… Read More
Humana pats itself on the back in new report
“Home health” has been a buzzword for years, even more so during the pandemic. It’s also been an investment focus for many health insurers – most notably, Humana. But two recent stories… Read More
Insurers start to feel the contract-cutting heat
In our opinion, hospitals usually bear more than their fair share of blame when insurers make cuts to their health plan networks. To be fair, not every hospital is always in the… Read More
Anthem and BlueCross BlueShield: A “whoopsies,” of sorts
In general, making a “whoopsie” is not terribly sinister. We can forgive the occasional mess-up. But for big insurers, when there’s a processing error, it’s a big deal. Case in point: Remember… Read More
UnitedHealthcare reconsiders pandemic underpayments
When it comes to underpaying for COVID-19 care, you almost can’t blame UnitedHealthcare for trying. Well, actually, we can. After providers, largely pediatricians, complained that United was paying them substantially below market… Read More
A royal flush of managed care mischief
Ohio, Mississippi, Arkansas, Illinois – and now, Iowa. By this point, you could probably tell the tale of misused state dollars as well as we can…but here we go again. In 2016,… Read More
One PBM is taking the “special” out of “specialty care”
When it comes to specialty conditions such as HIV/AIDS, multiple sclerosis, rheumatoid arthritis, anemia, and even cancer, the “special” label that describes the condition, medication and care isn’t a meaningless label. These… Read More