A report from the Office of the New York State Comptroller published Jan. 6 found Anthem Blue Cross either did not recover or remit over $19.3 million in hospital claim overpayments and relied on incorrect time periods to evaluate the…
Author: Elizabeth Casolo
The Council for Affordable Quality Healthcare is transitioning away from its nonprofit structure, sharing how the country’s biggest health insurance companies are now serving as owners, according to a Jan. 6 news release. CAQH was originally founded by a coalition…
Laws in North Dakota, Nebraska and Alaska focused on accelerating insurer response times for prior authorizations went into effect Jan. 1. North Dakota Gov. Kelly Armstrong signed the state’s bill in April. The legislation requires plans to decide on nonurgent…
Premera Blue Cross is expanding its case management resources for cancer care, according to a Jan. 6 news release. The patient navigation program, called Premera Cancer Support, relies on a partnership with Thyme Care, an oncology startup that focuses on…
The New York State Conference of Blue Cross and Blue Shield Plans voiced affordability concerns over three payer-focused mandates that went into effect Jan. 1. The mandates include first-in-the-nation scalp-cooling coverage for chemotherapy patients, EpiPen out-of-pocket caps and expanded access,…
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Youth mental health has been a pressing issue in recent years. With Medicaid as the country’s largest payer for mental health services, the program’s role is all the more essential. The National Academy for State Health Policy evaluated state Medicaid…
Clever Care Health Plan CEO Karen Walker Johnson, BSN, thinks her company’s edge is one that bigger insurers might have trouble replicating. That edge is Clever Care’s focus on offering “culturally sensitive Medicare options,” and it is baked into the…
A Colorado law equalizing behavioral and physical health in insurance coverage went into effect Jan. 1, preventing carriers in the state from limiting the “medically necessary treatment” of behavioral, mental health and substance use disorders. The law was passed in…
From $1 trillion in Medicaid cuts courtesy of the One Big Beautiful Bill Act to workforce shortages, Medicaid home- and community-based services are under pressure. KFF evaluated payment rates, provider closures and staffing issues through a 2025 survey. All states,…
New York Gov. Kathy Hochul blamed a 38% average spike in health insurance premiums for state residents on the Dec. 31 expiration of ACA enhanced premium tax credits. The average monthly increase for a New York couple is $228. Out…