Payer Issues Archives - Becker's Payer Issues

Humana posts $694M Q2 profit | ACA subsidy fallout favors insurers, pressures hospitals | CMS to end Part D subsidy program | Optum joins HHS behavioral health pledge | Centene's ICHRA membership hits 50K members

Humana beats Q2 profit estimates + the ACA subsidy fallout diverges for insurers, hospitals July 29, 2026 1. Humana turns $694M Q2 profit amid Medicare Advantage, CenterWell growth Full story 2. ACA subsidy fallout favors insurers, pressures hospitals’ payer mix Full…

Centene boosts '26 outlook | 4 more MA plans get 5 stars | 5 system vs. payer lawsuits to watch | CVS looks to dismiss 340B lawsuits | MA enrollment share to hit 57% in 2036

Centene posts $1.1B Q2 profit + 4 more MA plans upgraded to 5 stars July 28, 2026 1. Centene boosts guidance amid $1.1B Q2 profit, ACA membership drop Full story 2. 4 more Medicare Advantage contracts get 5 stars in…

Jefferson sues IBX over $100M in disputed pay | 5 payers entering ACA markets | Excellus to face racial bias lawsuit | HHS appeals pause on '25 ACA rule provisions | Ore. lifts supervision order on MA plan

Jefferson sues another payer over disputed pay + 5 payers entering ACA markets July 27, 2026 1. Jefferson Health sues Independence Blue Cross over nearly $100M in disputed payments Full story 2. Excellus BCBS to face former director’s racial discrimination…

Whistleblower claims Cambia kept MA overpayments | Aetna's CMO pushes back on the 'agentic bot war' | Molina to continue ACA pullback | Miss. revokes insurance licenses over ACA fraud | Mass. posts '27 merged market rates

An unsealed whistleblower suit alleges MA fraud at Cambia + Aetna’s CMO weighs in on the AI bot war July 24, 2026 1. Whistleblower alleges Cambia knowingly kept Medicare Advantage overpayments Full story 2. Aetna’s chief medical officer pushes back…

CMS appeals Clover's star ratings win | Payers face expanded price transparency rules | No Surprises IDR payouts hit $15B in '25 | Ex-Centene exec alleges age discrimination | Cigna eyes $200M cost savings via AI care management

No Surprises arbitration payouts explode + CMS appeals a landmark star ratings ruling July 23, 2026 1. CMS appeals Clover’s Medicare Advantage star ratings win Full story 2. Insurer pricing, claims data transparency bills advance in Congress: What to know Full…

Labor Dept. floats e-delivery for group plans | Meet the BCBS plan leaders | Calif. ACA market to gain 1 insurer | CMS pitches provider tax class for payers in Medicaid overhaul | 11 systems naming payer relations execs

Group plan e-delivery rule could mean $3.9B in savings + a Medicaid plan joins Calif. ACA market July 22, 2026 1. Labor Department pitches electronic disclosure rule for group health plans Full story 2. CalOptima to be California’s only new…

Newspaper beats UnitedHealth in court | HHS defers $1B+ in Medicaid payments to Minn., Calif. | UNC Health drops 340B lawsuits against Humana | Payers' prior auth promise, 1 year in | Meet 5 AI payer execs

UnitedHealth loses a defamation lawsuit + HHS pauses more state Medicaid funds July 21, 2026 1. Judge dismisses UnitedHealth’s defamation lawsuit against the Guardian Full story 2. HHS defers $1B+ in Medicaid funds to Minnesota, California Full story 3. Medicaid is entering…

Judge blocks '27 ACA rule provisions | Centene beats employee 401(k) lawsuit | UHC reduces MA enrollment loss projection | Federal bill pitches Medicare exchange plan | Where employers offer health benefits the most

Judge blocks ACA changes again + UHC expects to keep more MA members than it thought July 20, 2026 1. Judge pauses ACA catastrophic plan expansion, 7 other provisions Full story 2. UnitedHealthcare reduces MA enrollment loss projection for 2026…

Optum taps AI chief | UnitedHealthcare calls for IDR reform | Senate blocks move to repeal Medicare prior auth pilot | States ranked by self-funded, fully insured plans | A hidden cost of the GLP-1 boom

UHC wants changes to No Surprises arbitration + Senate blocks move to repeal WISeR July 17, 2026 1. UnitedHealthcare: No Surprises arbitration system ‘needs to be reformed’ Full story 2. Optum names chief AI officer Full story 3. Learn how Medica…

UnitedHealth posts $5.5B Q2 profit | Senators press MA insurers on AI-driven denials | Elevance signals more Medicaid exits | How Regence Ore. kept 98% of commercial members | 10 providers seeking payer talent

UnitedHealth boosts its margins + senators up the scrutiny on AI-driven denials in MA July 16, 2026 1. UnitedHealth posts $5.5B profit in Q2 Full story 2. Senators press UnitedHealth, Humana, CVS on AI-driven Medicare Advantage coverage decisions Full story…

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