Becker's Payer Issues | Payer News

Texas Attorney General Ken Paxton launched an investigation into Blue Cross and Blue Shield of Texas and its parent company, Health Care Service Corp., over potential denials and delays of medically necessary care, as well as prior authorization concerns. Mr.…

In 2026, 4.6 million Medicare Advantage beneficiaries, or 16% of enrollees, experienced disruptions to their health plan, according to a recent brief from the Alliance of Community Health Plans and consulting firm HealthScape Advisors. Hospitals have been dropping MA plans,…

Plans are expecting Medicare Advantage enrollment of 34 million beneficiaries in 2027, or about 47.4% of all Medicare enrollees, according to a Sept. 28 CMS news release. This would be flat compared with the 2026 projection, but actual MA enrollment…

UnitedHealthcare and TeamHealth have settled a lawsuit in which the insurer accused the physician staffing company of upcoding emergency department claims.  The lawsuit was voluntarily dismissed with prejudice Sept. 24 in Tennessee federal court, according to court records. The dismissal…

Medicare Advantage plan choice will fall in more than half of states in 2027, even as CMS projects lower average premiums and a nearly unchanged number of available plans nationwide. The decline follows widespread disruption in 2026, when as many…

Bobby Hunter has been named president of UnitedHealthcare. Mr. Hunter said Sept. 28 his focus in the new role will be on speeding up UnitedHealthcare’s modernization agenda, working toward a system where plans and providers work together more seamlessly, information…

Milwaukee-based Children’s Wisconsin named Bill Hanna as president of its affiliated insurer, Chorus Community Health Plans, Sept. 28. Mr. Hanna will oversee the direction and strategies for CCHP, which offers Medicaid coverage through the state’s BadgerCare Plus program. He will…

Sen. Mark Warner, D-Va., has introduced a bill that would roll back most of the healthcare cuts under HR 1, add a public option to the ACA exchanges and apply Medicare drug pricing rules to commercial health plans. 10 things…

While Medicaid Fraud Control Units have existed under federal law since 1977, the units have received renewed attention amid the Trump administration’s fraud, waste and abuse crackdown. KFF recently broke down the role of these state-level law enforcement entities and…

Wes Donohoe is serving as Optum Health’s CEO for AI and product innovation, the company confirmed to Becker’s Sept. 28. According to Mr. Donohoe’s LinkedIn post, he started the role, which focuses on AI and product innovation, Sept. 21. Mr.…