Becker's Payer Issues | Payer News

Nearly half of U.S. adults oppose AI playing any role in health insurance claim decisions, according to a Pew Research Center survey published Oct. 29. The survey of 3,488 adults, conducted in June, tested public openness to AI across eight…

Alignment Healthcare reported a net loss of $8.1 million in the third quarter amid higher-than-expected medical costs, according to its Oct. 29 earnings report. The company’s medical loss ratio was 89.5%, an increase of about 240 basis points year over…

A federal judge has partially denied a motion to dismiss a proposed class action accusing Anthem and Elevance Health of sharing member health data with vendors.  Anthem policyholders initially filed the complaint in an Indiana federal court in November 2025…

A federal judge in Massachusetts struck down a key part of CMS’ “medically frail” definition for Medicaid work requirement exemptions on Oct. 29. In June, 25 states and the District of Columbia sued the Trump administration over its interim final…

The Labor Department finalized a rule to promote transparency as pharmacy benefit managers work with large self-insured group health plans, shared during an Oct. 29 event.  The Wall Street Journal initially reported on the final rule one day ahead of…

Norfolk, Va.-based Sentara Health and Aetna have expanded their partnership to provide Medicare Advantage and Medicaid members with access to Sentara’s full network of hospitals, providers and care sites across Virginia. The agreement, which takes effect Jan. 1, 2027, will…

The Coalition Against Surprise Medical Billing and the ERISA Industry Committee sent letters to federal officials in late October, calling for more rigorous scrutiny of independent dispute resolution arbitrators under the No Surprises Act. Collectively, the groups represent employers, unions…

Physicians and practices win most No Surprises Act payment disputes. Collecting on those wins is another matter. Two federal appeals courts have now ruled that providers cannot sue insurers to enforce unpaid independent dispute resolution awards, and the Supreme Court…