Evidence

“Not allowed to retroactively deny emergency department (ED) claims? Well, then we just won’t pay out-of-network (OON) claims anymore.” We imagine this was idea that got thrown out at the latest meeting… Read More

As you know, UnitedHealthcare recently laid out its plan to put in place a policy allowing them to retroactively deny emergency department visits if the treatment shows it wasn’t an actual life… Read More

Remember how a few months ago we wrote about how pharmacy benefit managers (PBMs) are huge benefactors for profit growth within insurers (ahem, Anthem)? Well, it’s becoming a trend that keeps ascending for… Read More

“Come join our health plan—look at this huge list of in-network providers! Scroll through the directory and check out the breadth of our coverage! Just sign here.” Sounds like a good deal,… Read More

Remember when we covered the $2.67 billion class action suit against several Blue Cross Blue Shield (BCBS) plans in Michigan and the claims accusing them of price-fixing to squelch competition? We noted… Read More

Here’s what we’re wondering: Is there really a tsunami of patients set to crash down on the healthcare system as the pandemic dies down? Here’s what (we think) health insurers are wondering:… Read More

So, let’s say a woman you know is diagnosed with breast cancer, and with the right healthcare, she beats it. It’s a tough fight, but she beats it. Everybody breathes a sigh… Read More

We’re feeling a bit buffeted by multiple aftershocks here. Humana’s chess pieces just keep sliding around the board. First, the insurer snapped up full ownership of Kindred at Home, the biggest home… Read More

A new business dedicated to reducing the high cost of prescription drugs and curbing needless drug spending? Sure, we’re all for it. Setting up that business so that the health insurance investors… Read More

The latest in the saga of United’s ascent to the peak of Mt. Miserly is the case being brought against them by the California Medical Association (CMA). As reported by Healthcare Dive,… Read More

Health insurer Humana is on an acquisition roll, bringing yet another home health care provider into its fold. They just snarfed up One Homecare Solutions, which goes by Onehome, for an undisclosed… Read More

How about a bit of good news, for a change? Modern Healthcare ran a story about how Louisiana passed legislation ruling that insurers can no longer bypass hospitals’ in-house pharmacies in favor… Read More

Do you ever wonder whether some insurers may simply have chosen the wrong line of work? The basic exchange in health insurance entails receiving money from people who want their healthcare needs… Read More

United and two non-profit hospitals in Georgia’s Gwinnett County Northside Hospital system have parted ways. United accused Northside of “padding its bottom line at the expense of its patients,” while Northside took… Read More

In April, we covered Humana branding its health services arm to bring together its primary care, pharmacy, and in-home care services under the name CenterWell. While we pontificated on Humana’s dramatic growth, it… Read More

Let’s say you have a pain somewhere in your gut in the middle of the night. You’re not sure where it came from; it gets worse and then better, but it’s not… Read More

When Kentucky Fried Chicken changed its name to KFC there was little doubt in anyone’s mind that they were still serving up classic deep-fried poultry. But according to the company, the rebranding… Read More

As the COVID-19 pandemic upended our lives over the past year, many people delayed aspects of their medical care and postponed elective procedures. But now that the country is starting to open… Read More

On May 30, health insurer Cigna ended its contract with Virginia-based Mary Washington Healthcare. The reason it states is a failure of the two parties to come to terms on charges and… Read More

CVS Health’s vertical healthcare model is proving lucrative—and to us, is starting to look dauntingly powerful. As you may know, the company owns an international string of pharmacies, a pharmacy-benefit manager and—the… Read More

Cigna’s latest offering for its 14 million members is a behavioral health coaching, therapy, and psychiatry services app called Ginger. This new product is reflective of a steadily increasing demand for behavioral… Read More

Anthem (big health insurance company) is going to team up with Epic (large data analytics and health tech company) to leverage Epic’s massive medical records database for its internal purposes. Through this… Read More

We’ve heard of Munchausen syndrome by proxy, but Anthem’s latest billing snafu has us wondering if a new diagnosis is in order — Munchausen syndrome by payor. A report by the Office… Read More

We’ve shared before how we’re anxiously waiting to see how telehealth will be treated in upcoming contract hospital-insurer negotiations. Now, Congress is debating how to expand access to telehealth as the pandemic’s… Read More