Evidence

Occasionally, insurers determine that they have overpaid providers for care given to their plan members. Sometimes providers determine they have been underpaid by payors for care given to plan members. With a… Read More

Why does anyone buy health insurance? To ensure they have access to the healthcare services they and their families need. Unfortunately, having coverage today doesn’t always mean care is covered, nor does… Read More

During the COVID-19 pandemic, hospitals and health systems have fully embraced their role in responding to the public health crisis, moving mountains to offer community testing services and providing care for patients… Read More

Despite having offered what it characterizes as “extensive” financial assistance to its policyholders throughout the pandemic, UnitedHealthcare’s profits remain substantial nine months into the country’s battle with COVID-19. The Los Angeles Times… Read More

With all the vertical integration that’s happened across the insurance industry over the past decade, it’s not surprising that Optum sometimes gets lumped in with Aetna/CVS, Cigna/Express Scripts, and a series of… Read More

This March, after state investigators determined that Blue Cross Blue Shield of Texas had made major billing mistakes related to out-of-network emergency claims, the insurer agreed to pay a $10 million fine… Read More

The Mental Health Parity and Addiction Equity Act, passed more than a decade ago, requires insurers to cover mental health care in a way that is comparable to other medical treatments. Yet,… Read More

After posting a record $6.6B in profits for Q2—coinciding with the first wave of the COVID-19 pandemic—the industry giant saw profits drop in Q3 to $3.2B. Why? Because hospitals resumed both elective… Read More

In early 2018, it was announced that Cigna, one of the top five health insurance companies, had purchased Express Scripts, the last major independent pharmacy benefit manager, for $52 billion. The merger… Read More