The Latest

Bellaire, Texas-based Harris Health System filed a lawsuit against Elevance’s Wellpoint Texas, formerly Amerigroup Texas, due to alleged payment failures for Medicare Advantage beneficiaries, according to a March complaint. Harris Health began flagging payment delays in 2020. Following an escalation…

Park Ridge, Ill.-based Clear Spring Health will exit the Medicare Advantage market entirely on June 1, discontinuing its remaining business across Illinois, Georgia, and Colorado. The insurer, founded in 2017, had more than 12,000 members enrolled in its MA plans…

The Department of Labor’s Employee Benefits Security Administration has concluded that a proposed health plan sponsored by the Idaho Farm Bureau Federation qualifies as an employee welfare benefit plan under the Employee Retirement Income Security Act, according to an advisory…

For years, prior authorization has remained among the most contentious pressure points between payers and providers, but those tensions may finally be seeing tangible improvement. Over the last year, health insurers have made multiple voluntary commitments to reduce their requirements,…

From the first quarters of 2025 to 2026, Clover Health went from a $1.3 million loss to a $27 million profit, according to a May 6 earnings release. The company said it is expecting to have its first profitable year…

The largest insurers spent the first quarter navigating continued Medicare Advantage funding pressures, a slow and uneven path back to Medicaid profitability, a rapidly evolving prior authorization regulatory landscape, and mounting pressure to show returns on billions of dollars in…

As states float prior authorization reform, some are specifically targeting AI use with prior authorization and claims review. A May 6 KFF issue brief broke down where these policies stand and the role the federal government could play. Here are…

Portland, Ore.-based Legacy Health is back in network with Regence — a Blues carrier under Cambia Health Solutions — according to updates from both organizations. The agreement is retroactive to April 1, when Legacy went out of network. Without a…

Oscar Health is collaborating to launch ICHRAx, a data exchange for carriers and administrators working on individual coverage health reimbursement arrangements, CEO Mark Bertolini said on a May 6 company earnings call.  Mr. Bertolini said through the initiative, the company…