Becker's Payer Issues | Payer News

Recently, payers and providers have been engaging in a slew of transparency campaigns, with some aiming to “expose” pricing and denial concerns. For example, Hospital Watch has come to the forefront, shifting blame to hospitals. “Hospital Watch is a watchdog…

Two Connecticut cities filed federal lawsuits against Cigna, CVS Health and UnitedHealth Group — targeting their pharmacy benefit managers — over an alleged “insulin pricing scheme,” according to January filings in the U.S. District Court for the state. Along with…

EmblemHealth will pay $2.5 million after an investigation by the New York attorney general’s office found the insurer violated parity laws and failed to ensure access to mental healthcare services because of inaccurate listings, also known as “ghost networks.” The office launched…

UCare is in the throes of a state takeover in Minnesota, with health systems and former employees voicing concerns over the insurer’s rehabilitation.  The insurer posted an operating loss of $504 million in 2024 and shared plans to exit the…

Optum has launched Value Connect, an AI-powered platform designed to help payers and providers operationalize value-based care models by combining clinical, operational and financial data into a single system. The platform uses AI across quality measures, utilization patterns and risk…

Nevada identified insurer violations of mental health laws based on nonquantitative treatment limitations, according to a Dec. 31 report from the state’s insurance division. To better understand adherence to the Mental Health Parity and Addiction Equity Act, reviewers requested information…

A former senior director of data analytics at Optum was found guilty of defrauding the company out of more than $1.2 million through a scheme involving a fraudulent hire and salary kickbacks.  What happened? What’s next? 

One in 10 Medicare Advantage enrollees were forced to disenroll from their health plan heading into 2026 due to insurer exits from the market, a tenfold increase from historical averages, according to a study published Feb. 18 in JAMA. The…

Paul Markovich, president and CEO of Ascendiun, the parent company of Blue Shield of California, is not one to sugarcoat the state of the healthcare system. “I don’t see how you can look at it and say there isn’t a…

BCBS Michigan saved $67 million and $80 million in 2024 and 2025, respectively, through biosimilar use, the insurer reported Feb. 17. The company began moving members from Humira and Stelara to alternatives like Simlandi and Yesintek in 2025. Currently, 99%…