In recent months, payers across the country have tried tightening policies to get a better grip on evaluation/management coding. While payers often say the policies aim to control costs or combat fraud, these more restrictive policies are often met with…
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Network Health, a Wisconsin-based insurer owned by Froedtert ThedaCare Health, grew 37% during this past annual enrollment period to 126,000 total Medicare Advantage members, its second consecutive year of record growth. The plan also posted a 98% member retention rate.…
Sidecar Health members can now see a guaranteed price for nearly every physician visit in the U.S. before receiving care. The update covers all office visits nationwide, from primary care to specialists and therapists, as well as common add-on services…
Managed Medicaid plans have gone from above-target profit margins during the pandemic-era enrollment boom to aggregate underwriting losses, with early 2025 data suggesting the losses aren’t slowing, according to a February analysis from Wakely. The consulting group analyzed MCO financial…
Medicare Advantage enrollment grew less than 1% during this past annual enrollment period, but beneath that modest topline number was a dramatic reshuffling as national payers shed hundreds of thousands of members while smaller and regional plans posted some of…
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On Feb. 25, Centene offered CMS seven Medicaid reforms that would allow managed care organizations to take the reins in targeting fraud, waste and abuse in Medicaid. The letter called on CMS to: 1. Permit proactive payment suspensions without a…
From the departure of a longtime executive, to limiting employee raises, here are 10 updates on UnitedHealth Group and its subsidiaries that Becker’s has reported since Feb. 10. 1. UnitedHealth Group named Dennis Stankiewicz as chief accounting officer. Tom Roos,…
The insurer-backed Better Medicare Alliance, a Medicare Advantage advocacy group, and over 100 other organizations sent a letter Feb. 27 to CMS Administrator Mehmet Oz, MD, urging the agency to modify proposed 2027 rate levels for Medicare Advantage. The signatories…
CMS is sanctioning Elevance Health and plans to suspend enrollment into the insurer’s Medicare Advantage prescription drug plans, according to a Feb. 27 agency letter. The enrollment and communications pause is set to begin March 31 unless Elevance submits all…
ACA premiums for older adults have surged nationwide following the expiration of enhanced premium tax credits at the end of 2025, with increases varying dramatically by state, according to a Feb. 26 KFF analysis. The report examined how the loss…