Care and Access

Another ghost network story is giving us chills. A new whistleblower case reported in Modern Healthcare, alleges Aetna illegally secured contracts with Pennsylvania’s Medicaid program, HealthChoices, by misrepresenting the number of pediatricians… Read More

UnitedHealthcare is known for denying coverage. Old story, we know. But now, they’ve targeted pediatricians. Seems a little aggressive, right? The American Academy of Pediatrics (AAP) seems to agree, and they aren’t… Read More

You got your COVID-19 vaccine. You get your COVID-19 tests as necessary. Due diligence has been served, right? Well, don’t look behind you—here come the COVID-19 testing bills (and collection agencies). Per… Read More

Eating disorders are common—the mental health disorders affect nearly 30 million Americans. This is no small number, nor is the price tag associated with its care. An article in Becker’s Hospital Review… Read More

In a time when the Delta variant is raging and post-acute patient care is needed most, this is not the time for setbacks or bureaucracy. Leave it to insurers, though: Medicare Advantage… Read More

We sure hope you’re vaccinated, Michiganders! (And hope you don’t catch a breakthrough infection, despite your best efforts.) Your state’s two largest carriers are sunsetting COVID-19 cost waivers. You heard that right.… Read More

Introducing our newest hero: Illinois Governor JB Pritzker, who is throwing out new legislation for the betterment of healthcare in Illinois. The motive: calling into question the concept or execution of prior… Read More

We’ve covered it before: UnitedHealthcare’s business practices often make mental healthcare harder to access—and it seems like New York State agrees. We’re happy to report, per a recent Reuters article, that the… Read More

Vision can be an overlooked element of health. But not for Aetna, who launched a new policy requiring prior authorization for all cataract surgeries as of July 1. Per a recent article… Read More

Many would argue that Coke is not the same as Pepsi, yet the taste is close enough that they could swap if the other was unavailable. When it comes to prescription drugs,… Read More

The fun never ends when it comes to protecting patients from unfair out-of-network charges, per a July 30 Becker’s Review article.

Despite an already impressive growth in membership, Anthem is adding more to its expected year-end goals, reports a July 21 article in Healthcare Dive. Wondering how? Us, too!

You pay for insurance to help pay for healthcare, which includes your prescription medications. So, what happens when they stop covering those expenses? That’s exactly what 85-year-old Juanita Freeman’s was surely asking… Read More

And the telehealth saga continues. As we’ve said before, the COVID-19 pandemic opened many doors (even apps) for telehealth. Specifically, being able to provide patients access to care without going into the… Read More

We’ve covered a conglomeration of bad behavior from UnitedHealthcare – actions that many think negatively impact patients and providers alike, all in the name of profits. Now, we have a new ally… Read More

“Not allowed to retroactively deny emergency department (ED) claims? Well, then we just won’t pay out-of-network (OON) claims anymore.” We imagine this was idea that got thrown out at the latest meeting… Read More

As you know, UnitedHealthcare recently laid out its plan to put in place a policy allowing them to retroactively deny emergency department visits if the treatment shows it wasn’t an actual life… Read More

Remember how a few months ago we wrote about how pharmacy benefit managers (PBMs) are huge benefactors for profit growth within insurers (ahem, Anthem)? Well, it’s becoming a trend that keeps ascending for… Read More

“Come join our health plan—look at this huge list of in-network providers! Scroll through the directory and check out the breadth of our coverage! Just sign here.” Sounds like a good deal,… Read More

Here’s what we’re wondering: Is there really a tsunami of patients set to crash down on the healthcare system as the pandemic dies down? Here’s what (we think) health insurers are wondering:… Read More

A new business dedicated to reducing the high cost of prescription drugs and curbing needless drug spending? Sure, we’re all for it. Setting up that business so that the health insurance investors… Read More

United and two non-profit hospitals in Georgia’s Gwinnett County Northside Hospital system have parted ways. United accused Northside of “padding its bottom line at the expense of its patients,” while Northside took… Read More

Let’s say you have a pain somewhere in your gut in the middle of the night. You’re not sure where it came from; it gets worse and then better, but it’s not… Read More

On May 30, health insurer Cigna ended its contract with Virginia-based Mary Washington Healthcare. The reason it states is a failure of the two parties to come to terms on charges and… Read More