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Percentage of Medicaid recipients disenrolled for procedural reasons in 5 states
More than 80 percent of Medicaid beneficiaries disenrolled from the program were booted for procedural reasons in three states, according to a May 31 report from the Kaiser Family Foundation. -
GI societies 'reaffirm call' for UnitedHealthcare to delay prior authorization policy after meeting
An alternative to UnitedHealthcare's imminent gastroenterology endoscopy prior authorization policy was rejected by representatives from three GI societies, who said that they were "not in a position to appropriately evaluate the UHC proposal with the limited information presented." -
Massachusetts monitoring Point32Health following ransomware attack
Insurance regulators in Massachusetts are examining Point32Health after the company reported a data breach affecting its Harvard Pilgrim commercial and Medicare Advantage plans, State House News Service reported May 29. -
5 ways to improve payer price transparency data
Payers can do more to improve the usability of price transparency data, a group of researchers wrote in Health Affairs. -
Commercial insurance enrollees pay less for ultra-expensive drugs than Medicare Part D members: Study
Medicare Part D beneficiaries that don't receive low-income subsidies spend 2.5 times more out-of-pocket on "ultra-expensive" drugs than those with commercial insurance, a study published May 26 in JAMA Health Forum found. -
Medicaid work requirements axed from debt ceiling deal
Medicaid work requirements were not included in a debt ceiling deal between President Joe Biden and House Speaker Kevin McCarthy, The New York Times reported May 29. -
Aetna in the headlines: 7 recent updates
CVS Health is expecting Aetna's Medicare Advantage star ratings to hurt its 2024 outlook, and the payer is investing in more value-based care. -
States ranked by total residents with self-funded health coverage
California has the most residents enrolled in self-insured health plans through an employer, while Wyoming has the least, according to a health coverage report published by insurance trade group AHIP in April. -
States ranked by total Medicare Advantage members
Eight states have at least 1 million residents enrolled in Medicare Advantage plans, according to a health coverage report published by insurance trade group AHIP in April. -
The payer mix of each state in 2023
Utah has the highest percentage of residents enrolled in commercial health plans (68 percent), New Mexico has the highest percentage enrolled in Medicaid (28 percent), and Maine has the highest percentage enrolled in Medicare (22 percent), according to a health coverage report published by insurance trade group AHIP in April. -
Appeals court rules Florida hospitals' payment dispute case against Cigna can proceed
Eight Florida hospitals can pursue a lawsuit against Cigna after a federal appeals court on May 25 overturned a lower court's ruling in favor of the payer. -
Washington state directs Regence BlueShield to correct ambulance balance billing claims
The Washington state insurance commissioner is directing Cambia Health Solutions, parent company of Regence BlueShield, to correct claims in which members were "balance billed" for ambulance services. -
How payer, for-profit health system CEOs compare on pay
Most major payer CEOs earned millions more than for-profit health system leaders in 2022. -
Why UPMC's health plan saw 12% year-over-year membership growth
Pittsburgh-based UPMC's insurance services division grew from 4,033,737 total members in the quarter ended March 31, 2022, to 4,505,128 members in the quarter ended March 31, 2023, according its financial report released May 25. -
Medicare Advantage star ratings decline will cost CVS Health up to $1B in revenue
CVS Health is expecting Aetna’s operating income to decrease by up to $1 billion next year because the number of its Medicare Advantage members in four star plans has dropped significantly since last year, according to regulatory documents filed May 25 with the Securities and Exchange Commission. -
8 payers among Forbes' best employers for new graduates in 2023
Forbes recognized eight payers on its annual list of "America's Best Employers for New Grads," released May 23. -
Average hospital payer mix in every state
On average, Wisconsin hospitals have the highest commercial payer mix in the country (78.1 percent), while Washington, D.C., hospitals have the lowest (47.9 percent), according to an April analysis from Definitive Healthcare. -
CBO: Uninsured rate to reach 10 percent by 2033
More people will be uninsured in 2033 than in 2023 as Medicaid continuous coverage unwinds, and extended marketplace subsidies could be discontinued, according to the Congressional Budget Office. -
Walgreens wants Humana's $642M arbitration award vacated
Walgreens is asking a judge to overturn an arbitrator's $642 million award to Humana in a drug-pricing dispute between the companies. -
How four major payers compare on price transparency
Payers' price transparency files vary widely by size and number of billing codes, an analysis published in Health Affairs found.
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