Care and Access

Who is Centene, you may ask? This brazen health insurer shot up seemingly out of nowhere (well, Wisconsin) to become a significant player in the market, with annual revenues (and vertical integration… Read More

We talk a lot about Optum in terms of its place in the UnitedHealth Group family tree, and how it fuels its parent company United’s growth. But a recent piece in Fierce… Read More

To set the stage, let’s look at how things were before the pandemic. A recent report by the Government Accountability Office (GAO) paints a picture of a behavioral health system that was… Read More

In a recent article, Modern Healthcare shared some of the repercussions of a growing trend: health insurance companies taking patients’ pharmaceutical care from doctors. It’s clear that insurers can reap massive financial… Read More

The stats on the expansion of IngenioRx, Anthem’s pharmacy benefit manager (PBM), are hot off the presses—and the numbers are big. To help put them in context, here’s a quick primer on… Read More

On April 20, Healthcare Dive updated a story we’ve been following about the acquisition of telehealth company MDLive by Evernorth, the recently re-branded primary health services umbrella group of Cigna. The Dive story… Read More

A massive arrangement has been reached between Ohio and six insurance companies hired to coordinate Medicaid managed insurance for more than 3 million low-income and/or disabled state citizens. It’s set to go… Read More

Providers hoping to treat their patients with radiation therapy may want to add some extra hours to their billing departments’ budgets. (And while they’re at it, they might consider prescribing them some… Read More

So, here’s a clever way to bolster an insurance company’s annual profit report: Charge physicians to access claims payment data. Sound crazy? Well, that’s what UnitedHealthcare was doing, until recently, through its… Read More

Earlier this year, UnitedHealth Group’s Optum subsidiary bought itself a present: the data analytics firm Change Healthcare, which is a massive administrative network that processes claims and pharmacy requests for physicians and… Read More

As a post-pandemic future takes shape, many of us are anxiously waiting to see how telehealth will be treated in upcoming contract hospital-insurer negotiations. Some analysts predict that hospitals are going to… Read More

This isn’t the first time the American Hospital Association (AHA) has flagged insurance company policies that take decisions regarding patient care away from the physicians they know and trust. Just recently, we… Read More

As we recently noted, the Oklahoma Health Care Authority (OHCA) decided to shift management of its Medicaid business to four for-profit health insurance companies, including UnitedHealthcare, in a deal estimated to be… Read More

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

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

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 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

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

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

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

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

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

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

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