Evidence

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

“What you see is what you get” wasn’t the case for more than 200,000 consumers who thought they were scoring good deals on decent health insurance plans. Burned by a deceptive marketing… 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

Anthem recently reported $551 million in 2020 Q4 profits, a drop of 41% compared to the $943 million the insurer reported in Q4 of 2019. While at first glance, 41% may appear… 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

In early January, we shared our point of view on UnitedHealthcare’s planned acquisition of the data company, Change Healthcare. To no one’s surprise (at least not ours), there is some controversy surrounding… Read More

It is no secret that 2020 was a good—no, make that great—year for UnitedHealth Group. As we covered previously, even a “bad” quarter for this company was still leaps and bounds ahead… Read More

When we look at the trend toward vertical integration in the insurance industry (i.e., insurance giants gobbling up pharmacy benefits managers, data and analytics companies, specialty pharmacies, digital patient monitoring platforms, provider… 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

In October of 2020, we covered a story about health insurers rolling back coverage for telehealth services, right as demand was skyrocketing due to COVID-19. During the pandemic, virtual visits have been… 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

On January 4, 2021, Centene announced a definitive agreement to acquire Magellan Health, an insurer with a vast behavioral health network, for $2.2 billion. Centene claims that in light of the pandemic,… Read More

We rang in 2021 with yet another big move by UnitedHealthcare: its decision to cut Envision Healthcare from its network after the two companies were unable to come to an agreement regarding… Read More

It looks like prior authorizations—or more specifically, the myriad challenges providers face around prior authorizations—are becoming an Un-covered theme. If you’ve been following our feed, you’ll recall that we recently shared our… Read More

Looks like UnitedHealthcare might have been saving up all those profits to buy itself an extravagant New Year’s gift. In early January, United’s subsidiary Optum announced that it will purchase the technology… Read More

According to RevCycle Intelligence, a new survey of 200 hospitals conducted by the American Hospital Association (AHA)—and supplemented by interviews and group discussions with several hundred additional hospital and health system executives—found… Read More

Here’s a trend we saw in 2020 and will likely continue to see in 2021: UnitedHealthcare forcing providers to choose between accepting dramatic pay cuts or being cut out of United’s network.… Read More

Like most employers, the City of Philadelphia, MS, will be seeing the cost of health insurance for its employers increase next year. What’s unique about this story, however, is how clearly it… Read More

When Sam Bloechl was buying a comprehensive health plan, one he believed would cover him for a life-threatening illness; he did not know he was sick. A subsequent cancer diagnosis led doctors… Read More