Payer

UnitedHealth Group said a proposed class-action lawsuit alleging an AI algorithm wrongfully denied Medicare Advantage patients care should be dismissed because "plaintiffs have failed to exhaust the exclusive administrative appeal process set by the Medicare Act for challenging coverage determinations."

An Oklahoma bill reforming the prior authorization process has been signed into law and goes into effect Jan. 1, The Journal Record reported May 21. 

The ACA marketplace hit a record enrollment high of 21 million in 2024, buoyed by federal premium subsidies. In 2020, ACA enrollment was 11 million.

More hospitals are cutting ties with Medicare Advantage plans, and some insurers are bracing for membership losses in 2025. Here are seven Medicare Advantage updates Becker's has reported since May 8. 

Through pre-development loans, Centene and building developer McCormack Baron Salazar will enable around $900 million in planning and construction-related activity to accelerate the development of affordable housing. 

Vermont Gov. Phil Scott has signed a bill to reform the prior authorization process in the state.

GuideWell subsidiary WebTPA, a health benefits administrator, has started notifying more than 2.4 million members about a data breach that occurred in April 2023, The HIPAA Journal reported May 20.

Here are eight lawsuits, settlements and legal developments involving payers that Becker's has reported since April 1: 

Medicare Advantage is the dominant form of Medicare, and questions loom for payers, providers and policymakers alike in the year ahead. 

Employer adoption of ICHRAs is up 29% since 2023, according to a May 16 report from the HRA Council.