Premera Blue Cross is suing a weight loss clinic, its physician-owner and its revenue cycle management firm, alleging repeated abuse of the No Surprises Act’s independent dispute resolution process to extract inflated payments from the insurer. The lawsuit, filed April…
Author: Jakob Emerson
Texas saw the largest increase in bronze ACA plan enrollment from 2025 to 2026, while West Virginia saw the largest decrease, according to CMS data analyzed by KFF. Bronze plan enrollment grew 26% nationally, from 7.3 million to 9.2 million,…
The day after CMS released its final 2027 Medicare Advantage and Part D payment rule, Chris Klomp, director of Medicare and deputy administrator at the agency, sat down with Health Tech Nerds Radio podcast to walk through what changed, what…
CMS has issued operational guidance to states regarding how to implement H.R. 1’s Medicaid coverage restrictions for noncitizens, which take effect Oct. 1. On April 8, the agency outlined how states must update eligibility systems, applications, verification processes and claims…
AP of South Florida, a Florida-based insurance brokerage, has agreed to plead guilty to one count of major fraud against the U.S. for its role in a fraudulent ACA enrollment scheme. In a parallel civil resolution, AssuredPartners, a national brokerage…
Advertisement
Cigna Healthcare offers the best digital experience to commercial members, while UPMC Health Plan provides the best experience to Medicare Advantage enrollees, according to JD Power’s 2026 U.S. Healthcare Digital Experience Study. Both plans topped their respective segments in last…
At the start of this year, Florida Blue launched two specialty pharmacy programs aimed at reducing drug costs for members on high-priced therapies. The programs, dubbed FlexAccess and Advocate+ Pharmacy Match, address affordability from two different angles. FlexAccess works on…
Insurers have eliminated 11% of prior authorization requirements across a range of medical services since June, representing 6.5 million fewer prior authorizations for members, according to an AHIP-Blue Cross Blue Shield Association survey published April 7. Five notes:
Washington, D.C. has the highest average monthly premium for ACA enrollees who received advance premium tax credits in 2026, while Texas has the lowest, according to a KFF analysis. After enhanced premium tax credits expired at the end of 2025,…
Elevance Health is bringing its out-of-network provider penalty policy to New York on July 1, continuing a state-by-state expansion that has drawn legislative backlash and opposition from hospitals and physician groups. Under the policy, in-network facilities in New York that…