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Texas bill takes aim at AI-based coverage denials
A Texas lawmaker has introduced a bill that would prohibit payers from using artificial intelligence to delay, deny or modify claims, NBC affiliate KXAN reported Jan. 21. -
10 providers seeking payer contracting talent
Ten providers recently posted job listings seeking leaders in payer contracting and relations. -
OIG: Florida Blue received $6.7M in overpayments for federal employee benefits
Federal regulators questioned $8.47 million in charges from Florida Blue and its administration of the Federal Employees Health Benefits Program from 2018 to 2023. -
Persistent gaps seen in mental health parity enforcement: Report
Payers are making strides in addressing disparities around mental health and substance use disorder care services but are still falling short of achieving parity under the Mental Health Parity and Addiction Equity Act, according to a Jan. 17 report to Congress from HHS, and the Labor and Treasury Departments. -
CMS issues flurry of Medicare fines to payers
CMS issued nearly $2.5 million in fines on Jan. 17 across multiple health plans for Medicare contract violations related to Part C maximum out-of-pocket limits and cost-sharing requirements, and Part D coordination of benefits and low-income subsidy requirements. -
Care costs keep climbing for UnitedHealth
The medical cost challenges that have challenged insurers in 2024 will not be going away in 2025, UnitedHealth Group executives said. -
Why aren't Medicare Advantage enrollees using supplemental benefits?
Though Medicare Advantage beneficiaries are more likely to have coverage of vision, dental and hearing services, they are not more likely to use these services than their peers in traditional Medicare, a study published Jan. 14 in JAMA Network Open found. -
UnitedHealth's plan to defend its PBM: 5 things to know
Optum Rx will pass 100% of the rebates it negotiates for drugs onto its consumers by the end of 2028, UnitedHealth Group CEO Andrew Witty told investors. -
UnitedHealth Group CEO: Healthcare has to 'function better'
UnitedHealth Group's CEO, Andrew Witty, said the company is committed to reducing prior authorizations and improving customer satisfaction on the company's first investor call since the murder of UnitedHealthcare's previous CEO, Brian Thompson. -
Centene launches behavioral housing model in Hawaii
Centene's 'Ohana Health Plan has partnered with homeless services provider Hope Services Hawaii on a new residential program for integrated clinical care. -
UnitedHealth profit falls to $14.4B in 2024
UnitedHealth Group reported record revenue in 2024, but profits declined as the company continues to grapple with costs associated with the February cyberattack on Change Healthcare and headwinds within its insurance business, according to the company's year-end earnings report released Jan. 16. -
Clover, Alignment grow Medicare Advantage enrollment
Two relatively new insurers in the Medicare Advantage market saw spikes in enrollment for 2025 -
Lawsuits over Medicare Advantage star ratings pile up
CMS is facing at least a half-dozen lawsuits over its 2025 Medicare Advantage star ratings. -
Blues plans back health solutions platform in $40M funding round
Solera Health has received $40 million in Series E financing, co-led by Health Care Service Corp., Cobalt Ventures, Horizon Mutual Holdings, and Adams Street. -
Medicaid spending ranked by share of state budgets
Texas has the highest Medicaid spending as a percentage of total state expenditures, while Wyoming has the lowest, according to KFF. -
Anthem Blue Cross pledges $10M for LA wildfires support
Anthem Blue Cross and its foundation have pledged an initial $10 million in grants for disaster response efforts amid the ongoing wildfires in Los Angeles County. -
Why these 5 BCBS companies restructured
Blue Shield of California is the latest Blue Cross Blue Shield company restructuring to keep up with the rapidly evolving payer landscape. -
Supreme Court to hear ACA preventive care coverage case
The Supreme Court said Jan. 10 it would hear the landmark case that challenges a federal task force's authority to require insurers to cover preventive care services under the ACA. -
Activist shareholders press UnitedHealth on delayed, denied care
A group of shareholders requested UnitedHealth Group management analyze how its business practices affect access to care and public health. -
Centene names first ICHRA president
Centene has named Alan Silver president of its Ambetter Health Solutions business, which focuses on ICHRA.
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