Health plans are getting squeezed from several directions at once. Administrative costs press against the medical loss ratio ceiling, new prior authorization rules set binding turnaround times and require public denial reporting, and members and providers expect answers in minutes.…
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CVS Health’s Aetna is expanding prior authorization bundles for cancer, available to some Medicaid members as of Sept. 1. The update impacts Medicaid members with providers in Oklahoma, Illinois, Maryland, New Jersey, Virginia, Florida, Kentucky and West Virginia who use…
PHI Air Medical, an air ambulance company, suspended operations at the Red Bluff Air Medical Base at Red Bluff Airport in California amid reimbursement tensions with insurers. A Sept. 14 PHI news release shared with Becker’s specifically blamed Elevance Health,…
Dispute activity under the No Surprises Act continues to evolve, court decisions are influencing the regulatory landscape, and the Final Rule could change how health plans and healthcare organizations approach key requirements. This session offers a data-driven look at where…
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Immediate jeopardy has been fully removed at Ascension St. Thomas Hospital in Nashville, Tenn., following a Sept. 4 revisit survey, according to a Sept. 16 letter obtained by Becker’s. But a 99-page Statement of Deficiencies shows the hospital remains out…
When Providence announced it was shutting down its health plan earlier this year after a $102 million loss in 2025, it joined a growing list of health systems stepping back from the insurance business. Carle Health’s Health Alliance, Michigan Medicine’s…
Point32Health, which includes Harvard Pilgrim Health Care and Tufts Health Plan, appointed Todd Walthall to its board of directors. According to a September news release, Mr. Walthall previously served as Optum Health’s chief growth officer, led payer markets at Optum…
UnitedHealthcare’s acquisition of nearly 300 ASCs over the last decade wasn’t associated with reduced procedure volume, fewer physicians, changes to patient mix or worse quality of care, according to a study published in the September issue of Health Affairs. The…
For too long, Medicare Advantage has rewarded plans for becoming better at documenting how sick their members are. The next era should reward them for demonstrating how much healthier they make their members. Medicare Advantage is now the dominant alternative…
The National Committee for Quality Assurance has named the highest quality and most effective health plans of 2026 based on clinical quality, patient experience and health plan accreditation status. The ratings were released Sept. 16 and are based on 2025…
