Anthem Blue Cross of California is holding off on its evaluation and management claim downcoding policy until March 1, pending California Department of Managed Health Care review, according to a Feb. 23 California Medical Association news release. The organization had…
Author: Elizabeth Casolo
EmblemHealth is partnering with Mae Health, a digital platform that connects expectant mothers to culturally responsive doulas, according to a Feb. 24 news release shared with Becker’s. The collaboration will target EmblemHealth Medicaid members. Doulas can assist with education around…
SCAN Health Plan will start a “Brokers as Health Navigators” program across its Arizona, Nevada, New Mexico, Texas and Washington markets, according to a Feb. 23 news release. “Many of the best brokers are already acting as trusted advisors, guiding…
In February, CMS released a final report on its Accountable Health Communities model, which launched in 2017 and ran until 2023. The model focused on addressing “upstream drivers of health,” or social determinants, for Medicaid and original Medicare beneficiaries. These…
One question was at the root of Aetna Better Health of Illinois’ recent partnership with Elektra Health, a virtual menopause care platform: “Where are we seeing healthcare needs popping up that don’t have a solution?” During an episode of the…
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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…
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…
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…
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%…