Musculoskeletal spend is a top driver of healthcare costs—but it’s also one of the few areas where plan-year savings are realistic when AI-care is applied early. New research shows that when members begin MSK care through an AI-enabled, virtual-first care…
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Alabama insurers issued the highest amount of medical loss ratio rebates to consumers in 2024, according to KFF. Under the ACA, if an insurer in the individual market spends less than 80% of premium revenues on clinical services and quality…
Delaware’s largest payer controls 93% of the state’s health insurance market, while Washington state’s largest insurer controls just 24%, according to KFF. The 2023 data was obtained from the “Health Coverage Portal TM,” a database maintained by Mark Farrah Associates. …
Health insurers face a wave of regulatory and policy changes in 2026, from the expiration of enhanced ACA premium tax credits to tighter prior authorization rules and new state coverage mandates. Here’s a rundown of major federal and state payer…
As the end of 2025 approaches, so do a handful of payer-provider agreements. Earlier this year, the number of contract disputes were down. While some insurers and health systems reach a resolution — either before or even after their deadlines…
Medical loss ratios are crossing 90%, and traditional payment integrity models can’t keep up. Teams waste months digging through vast amounts of unstructured documents, including CMS guidelines, reimbursement policies, contracts, and coding manuals, only to generate rules that never yield…
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Blue Cross and Blue Shield of Alabama is dropping its Medicare fitness benefit, a spokesperson confirmed Dec. 31 to Becker’s. A spokesperson for the insurer said it reevaluates its Medicare benefits “to ensure our products are competitive and remain financially…
Cigna and Dallas-based Tenet Healthcare reached an agreement in their contract dispute, a Cigna spokesperson confirmed Dec. 31 to Becker’s. Tenet has 64 hospitals, nearly 370 ambulatory surgical centers and roughly 2,000 providers across the country. “An agreement has been…
Health Care Service Corp.’s Blue Cross and Blue Shield of Texas filed a lawsuit against medical billing company Zotec Partners Dec. 18, alleging “abuse” of the No Surprises Act’s independent dispute resolution process, according to filings from the Eastern District…
Health Care Service Corp.’s Blue Cross and Blue Shield of Texas and Austin-based Ascension Texas reached an agreement Dec. 31, just ahead of their end-of-year deadline, according to the insurer. Now, all members — spanning commercial, ACA and Medicare Advantage…
