California’s Department of Managed Health Care issued Anthem Blue Cross a $15 million fine due to “longstanding and widespread failures” with handling member complaints, according to a Jan. 30 news release from the department. The enforcement action also stipulates that…
Author: Elizabeth Casolo
Sidecar Health is bringing its fully insured health insurance product to Texas, according to a Jan. 22 news release. Sidecar said Texas is one of the largest employer markets in the U.S. According to recent survey data, about one-third of…
Point32Health — which includes Harvard Pilgrim Health Care and Tufts Health Plan — appointed Marti Lolli as executive vice president, chief growth officer, and Jeff Weiss as executive vice president, corporate strategy and strategic partnerships. Both will report to President…
The Labor Department’s Employee Benefits Security Administration proposed regulation Jan. 29 that would require pharmacy benefit managers to disclose their compensation with self-insured group health plans. Under the rule, PBMs would have to share information on their rebates and other…
Payer-provider dynamics have been a persistent struggle in healthcare, particularly evident in heated contract negotiations. AI — such as clinicians using scribes associated with greater coding intensity and insurers harnessing AI platforms to authenticate claims and assist with prior authorization…
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Combined profit margins across BCBS plans sank to 1.4% as of third-quarter 2025, according to a Jan. 29 analysis of Mark Farrah Associates’ Health Coverage Portal. The report covered BCBS Association licensees and unaffiliated plans. The team compared composite third-quarter…
BCBS Vermont President and CEO Beth Roberts has worked all over New England — but her latest role marks her first foray into Vermont. She described the state’s insurance market as “interesting” in a recent interview with Becker’s, laying out…
Managed care company Molina Healthcare is partnering with HealthStream’s MissionCare Collective — which hosts a career network and job portal for CNAs and caregivers — to expand home health aide training in an effort to create 15,000 roles, according to…
Medicare Advantage insurers made almost 53 million prior authorization decisions in 2024, according to a Jan. 28 KFF analysis. KFF relied on insurer data reported to CMS, focusing on service determinations, not claims determinations for services already provided. Withdrawn and…
A Kentucky bill introduced Jan. 21 would require the state’s insurers to offer prior authorization exemptions in the state. The bill has bipartisan backing and includes two Republican healthcare professionals — state Reps. Kimberly Moser and Robert Duvall — as…