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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.
Evidence
All the proof that payors are putting wealth over health.
We’ve made it another half-year. Guess which health insurer is in the lead (again).
We’ve made it another half-year. Guess which health insurer is in the lead (again). Another earnings season, another unfathomably large profit for our nation’s largest health insurance company (and the rest aren’t… Read More
How insurance companies police doctors through arcane policies
Insurers never miss a chance to make getting healthcare harder, do they? A new report from Modern Healthcare claims both Horizon Blue Cross Blue Shield of New Jersey and Cigna are planning… Read More
Hospitals may catch a break in insurer negotiations (but we’re not holding our breath)
Dare we say we have . . . good news? Could it be that payers are finally acknowledging how expensive it is to operate a hospital? According to a recent article in… Read More
Rural or otherwise, running a hospital is no walk in the park
Running a hospital is serious business. Sure, we can talk theoretically all day about payors, providers, and the pandemonium that is healthcare . . . but the reality of the situation is… Read More
Insurance contract disputes: when the odds are not in patients’ favor
They say all’s fair in love and war. Well, not when it comes to health insurance contract disputes. At least, such is the case for one local community in California. Adventist Health… Read More
Another prior authorization delays patient care and ends in tragedy
OK, we admit it. We’re (fairly) snarky when it comes to health insurance companies. But there’s no room for snark when it comes to a recent Medscape article, which follows the journey… Read More
TeamHealth and UnitedHealthcare get in the ring . . . again
Does a Nevada lawsuit with UnitedHealthcare (United) sounds familiar? Well, since TeamHealth filed ten lawsuits against UnitedHealth Group last December, alleging underpayment for TeamHealth physicians – it might! In the first case,… Read More
Health insurers don’t want to cover your care—their chronic denials prove it
In 2020, amid a global pandemic, health insurers on the Affordable Care Act marketplaces denied close to one-fifth of all in-network claims, according to a Healthcare Dive article citing Kaiser Family Foundation… Read More
Optum takes its joint ventures to the next (vertical) level
Is there any type of business that health insurance giant UnitedHealth Group won’t try to stick a flag in? Per a July 11 article in Modern Healthcare, UnitedHealth’s massive physician group, Optum,… Read More
Connecticut AG pushes back on health plan premium hikes – again
Summer in New England is quite nice – our Northeastern friends often enjoy somewhat cooler temps than the rest of the country. Unless you’re an insurance plan, in Connecticut. Then you’re (appropriately)… Read More
Will new federal rules bring health insurers’ shady negotiation tactics to light?
It’s finally here – after wrangling substantially more time to prepare than hospitals had, insurers are now required to post their negotiated prices publicly on their websites. According to Fierce Healthcare, the… Read More
The Fallacies of Folwell, Part Deux
Provider Relief Funds (PRF) have allowed many of North Carolina’s hospitals to continue operating when they otherwise would have buckled under the burden of COVID-19. Unfortunately, North Carolina Treasurer Dale Folwell doesn’t… Read More
Just how profitable have health insurers been in the last few years?
If you’ve been reading Un-covered for a while, you’re probably well aware that health insurers have been extremely profitable in the last few years. Even so, new information continues to demonstrate just… Read More
Aetna sees the light (finally)
Has a health insurer actually seen the harm their restrictive policies cause for patients? According to a recent article in Fierce Healthcare, Aetna is coming to terms with the fact that last… Read More
N.C. State Health Plan Report Lacks Critical Context
Dale Folwell, North Carolina’s Treasurer, recently commissioned and endorsed the findings of a one-sided, short-sighted report. Its title, ‘North Carolina Hospital Systems Enjoyed Record Profits During Pandemic,’ smells of click-bait. It’s curious… Read More
‘No-fault’? Yeah, right. Centene’s foibles are starting to add up
It’s been a while since we’ve done a good ‘ole update in our series, Managed Care Mischief. But not to worry — we’re back and headed to New Mexico, where Centene, known… Read More
Can you guess which health insurer has a history of tax breaks?
Benjamin Franklin once said, “Nothing is certain except death and taxes.” Well, apparently, not true for Blue Cross Blue Shield (BCBS). According to a new report from STAT News, many BCBS plans… Read More
Prices are up. But insurance premiums? Way up.
It’s no secret that consumer prices are high. (Hello, gasoline.) But whether it’s housing, utilities, or food, costs across the board are continuing to rise. In fact, at 8.6%, inflation is the… Read More
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
For Anthem, a rose by any other name . . .
Drumroll, please. Because later this month, Anthem will become … wait for it: ‘Elevance Health.’ This is the health insurance company’s second rebrand in a decade, and you’re not alone in wondering… Read More
That ‘no-name’ drug in your cabinet? It may not be saving you as much as you think.
Let’s face it: the only reason we buy generic goods is to save money. (And when it comes to healthcare, there’s a lot that inevitably needs to be saved.) This is especially… 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
It’s time for another contract dispute round-up
Are insurer contract disputes ‘business as usual’? A recent Becker’s Payer Issues article rounds up eight recent disputes between health plans and hospitals — from Maine to Mississippi, Colorado to Georgia, and… 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