Evidence

The jury has deliberated; the gavel has landed, and an insurance company is forced to face the repercussions of its actions. According to a recent article in Modern Healthcare, Tennessee-based emergency physician company… Read More

In our opinion, hospitals usually bear more than their fair share of blame when insurers make cuts to their health plan networks. To be fair, not every hospital is always in the… Read More

Pharmacy business managers (PBMs) control the cost of prescriptions for patients. This might sound like a good thing – theoretically, by monitoring prescription costs, PBMs are supposed to increase access to necessary… Read More

In general, making a “whoopsie” is not terribly sinister. We can forgive the occasional mess-up. But for big insurers, when there’s a processing error, it’s a big deal. Case in point: Remember… Read More

When it comes to underpaying for COVID-19 care, you almost can’t blame UnitedHealthcare for trying. Well, actually, we can. After providers, largely pediatricians, complained that United was paying them substantially below market… Read More

Ohio, Mississippi, Arkansas, Illinois – and now, Iowa. By this point, you could probably tell the tale of misused state dollars as well as we can…but here we go again. In 2016,… Read More

Today, we’re talking about “clawbacks.” And yes, they are as scary and painful as they sound. Before we explain what’s going down in the Buckeye State, here’s a refresher on PBMs. These… Read More

When it comes to specialty conditions such as HIV/AIDS, multiple sclerosis, rheumatoid arthritis, anemia, and even cancer, the “special” label that describes the condition, medication and care isn’t a meaningless label. These… Read More

Ah, fall. The temps are dropping, Thanksgiving is just around the corner, the Christmas holiday will be here before we know it, and… insurers are cutting hospitals out of their networks. Wait,… Read More

It seems like the rollercoaster that never drops. As if you couldn’t guess, yes, we’re talking third-quarter earnings for two of the biggest insurers. Anthem and UnitedHealthcare saw a dramatic increase in… Read More

Surprise bills, be gone! Spooky season may be over, but the holiday season is here, and we still hope there’s some magic left in the air to rid patients of surprise bills… Read More

We’ve said it before: Optum is getting bigger. A subsidiary of UnitedHealthcare, Optum has inked its largest health system deal yet, Healthcare Dive reports. After another successful quarter (if you’re a shareholder,… Read More

Big Appliance. Big Oil. Big Dairy. Big Pharma. Annnnnd Big Health Insurer. Not that we needed more evidence to prove the big business of health insurance, but a recent article in Modern… Read More

Anesthesiologists are in a painful situation, which is unfortunate considering their job is to help manage pain. In a recent article in Modern Healthcare, the American Society of Anesthesiologists (ASA) claims that… Read More

Our friends Centene Corporation are back with the next installment of our favorite series: Managed Care Mischief. According to an article in Healthcare Dive, Centene’s settled another set of allegations that it… Read More

A pair of insurers have yet to pay their bills, and we aren’t talking chump change. Provider representatives say the insurers are billions of dollars behind on payments owed to hospitals and… Read More

Finally, at (very) long last, the Department of Health and Human Services (DHHS) is putting the many pieces of Medicare fraud together. An exclusive report in the Wall Street Journal explains that… Read More

Word on the street (StreetInsider, to be specific) is that Humana has its eye on a shiny new purchase: Medicaid managed-care organization (MCO), Centene. A recent Fierce Healthcare article gives us the… Read More

Remember back in May, when Blue Cross Blue Shield (BCBS) settled for a cool $2.67 billion in a highly publicized antitrust case? We sure do. Here’s a refresher: The BCBS Association was… Read More

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

The Centers for Medicare & Medicaid Services (CMS) suspended enrollment in not one, but three Medicare Advantage plans offered by UnitedHealthcare. What happened? Well, the Social Security Act requires that health insurance plans have… Read More

We interrupt our regular programming to take you back to Connecticut, where insurance scrutiny remains high. Which, if we’re being honest, is our regular programming. Just last week, we covered the Connecticut… 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

Change is a-coming, as it normally does during a new legislative year. This year, Congress is mid-debate on Biden’s bipartisan infrastructure bill and Democrats’ $3.5 trillion reconciliation bill, which includes Medicare reform.… Read More