Featured Content
L.A Care Health Plan is the largest Medicaid managed care organization in the U.S. with nearly 2.4 million enrollees, according…
The Latest
Point32Health reported a $301 million operating loss in 2025, offset by $167 million in investment income for an adjusted net loss of $141 million. The insurer, parent company of Harvard Pilgrim Health Care and Tufts Health Plan, posted revenues of…
This February, BCBS Michigan shared how it will cut reimbursement by 50% for nonpreventive evaluation/management services with modifier 25 that were billed on the same day as procedure codes with global periods of zero, 10 or 90 days. However, the…
Novant Health, a 19-hospital system headquartered in Winston-Salem, N.C., has partnered with the North Carolina State Health Plan — which is administered by Aetna — to expand access to “no-cost surgical care” for hundreds of thousands of plan members across…
Eli Lilly has launched Employer Connect, a platform that offers employers a direct route to offer Zepbound coverage to workers at a list price of $449 per month, bypassing traditional pharmacy benefits. The platform pairs employers with more than 15…
CMS reported a record of nearly 47,000 comments on its Medicare Advantage payment proposal for 2027. The insurer-backed Better Medicare Alliance, an MA advocacy group, hosted an executive summit March 3, featuring CMS Director of Medicare and Deputy Administrator Chris…
Three of four Regence health plans ended 2025 with operating losses as medical and drug costs climbed across Oregon, Washington, Idaho and Utah, according to results published by the organizations on March 2. The Washington plan was the hardest hit.…
Excellus BlueCross BlueShield ended 2025 with a 1.4% operating loss totaling $108 million, as medical and drug claims climbed 16% year over year to nearly $7 billion. The insurer said March 5 the results are its largest annual claims increase…
UnitedHealth Group reported only 10 subsidiaries in its U.S. Securities and Exchange Commission filings for 2025, down from thousands in 2024. UnitedHealth has expanded greatly over the last decade. For example, in 2022, UnitedHealth overcame federal antitrust concerns and was…
Clover Health said it is the first health insurer to be live on a CMS-aligned network for patient-directed requests, according to a March 4 news release from the company. While CMS previously listed other payers as “early adopters” of CMS-aligned…
In recent months, payers across the country have tried tightening policies to get a better grip on evaluation/management coding. While payers often say the policies aim to control costs or combat fraud, these more restrictive policies are often met with…
